Endobronchial ultrasound convex-probe transbronchial needle aspiration as the first diagnostic test in patients with pulmonary masses and associated hilar or mediastinal nodes

Background: In the diagnosis of patients with a lung mass and hilar or mediastinal lymph nodes (N1or N2) it may be that patients are unnecessarily having biopsies of the primary lung cancer when sampling of the nodes would give both a tissue diagnosis and staging. By comparing node station and size in patients having just one procedure (endobronchial ultrasound transbronchial needle aspiration [EBUS TBNA]) with those having extra procedures on the primary mass before EBUS TBNA, similarity of nodes in the two groups might suggest that the extra procedures were unnecessary. Methods: A prospective case series of patients with coexistent lung mass and N1or N2 nodes compared results for EBUS TBNA in patients with no prior bronchoscopy (group A) with patients who had a bronchoscopy or transthoracic needle aspiration elsewhere directed at the primary mass (group B). Results: Sixty-eight EBUS TBNA procedures were carried out in 67 patients with 23 patients in group A, and 45 in group B. Nodes sampled included stations 2, 3, 4, 7, 10, 11 and 12. Node size was approximately the same in both groups, 16.5 +/- 6 mm in group A and 16.9 +/- 6 mm in group B. For malignancy sensitivity by EBUS TBNA was 94% in group A and 95% in group B, with surgical sampling showing three TBNA false negatives. Conclusion: There was no difference between the two groups in node size or location. Diagnostic yield overall was high. With expanding use of EBUS TBNA, a new guideline for its initial application in such patients could reduce the overall number of procedures.