Aims:
Very few studies have compared the diagnostic utility of these two tests in sub-carinal
lymphadenopathy. The aim of this study was to compare effectiveness and safety of
both modalities and assess their diagnostic accuracy.
Methods:
In this retrospective cross sectional study, data were collected from patients who
underwent either EBUS-TBNA or EUS-FNA of sub-carinal lymphadenopathy for a range of
clinical indications between February 2013 and August 2015, at Shaukat Khanum Memorial
Cancer Hospital & Research Centre, Lahore. Histopathology, clinical and radiological
follow up was considered as gold standard to calculate the sensitivity, specificity,
NPV and PPV.
Results:
In total, 131 eligible patients (mean age 49.69 years; range 8 – 87; 51.9% males)
were reviewed. Of these, 82 patients had EUS-FNA (mean age 49.68 years; range 8 –
83; 51.2% males) and 49 patients underwent EBUS-TBNA (mean age 49.69 years; range
12 – 87; 53.1% males) of sub-carinal lymph nodes. The diagnostic yield of EUS-FNA
and EBUS-TBNA were 91.4% vs. 71.4% pvale:0.005. Only one patient in each group suffered
a complication and was managed conservatively. The sensitivity, specificity, PPV and
NPV for EUS-FNA was 92.8%, 100%, 100% and 28.5% whereas for EBUS-FNA, it was 83.8%,
100%, 100% and 69.3%.
Conclusions:
Beyond doubt, both EUS-FNA and EBUS-TBNA are the future of mediastinal staging obviating
the need of futile or unnecessary invasive staging procedures due to their minimally
invasive approach, accuracy, safety record and diagnostic reach. EUS FNA should be
considered as a first line investigation for the evaluation of subcarinal lymph nodes.
