A HEAD TO HEAD ANALYSIS OF ENDOSCOPIC ULTRASOUND AND ENDO-BRONCHIAL ULTRASOUND GUIDED FINE NEEDLE ASPIRATION OF SUB-CARINAL LYMPHADENOPATHY

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.