Diagnostic Yield of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration in Mediastinal Lesions - Mass / Lymphadenopathy

Abstract

Introduction: Lymphoma, thymoma, germ cell tumors, neurogenic tumors, mediastinal goitres, and other conditions with mass manifestations tend to occur in the mediastinum. A precise diagnosis and staging of mediastinal Lymph nodes and disease are imperative to administer suitable treatment. Endobronchial ultrasound-guided transbronchial needle aspiration is a notably accurate and secure technique for procuring histological and cytological samples from enlarged mediastinal lymph nodes.  Furthermore, EBUS is indispensable for the evaluation and clinical monitoring of mediastinal lymphadenopathy. Hence, the purpose of our study was to assess the diagnostic efficiency of TBNA with Endobronchial Ultrasound guidance in Mediastinal Lesions (mass/lymphadenopathy).

Materials and method: The present study was carried out as a hospital-based cross-sectional study on 60 patients with Mediastinal Mass/lymphadenopathy (above 18 years of age) of either sex, attending the Respiratory Medicine Department of a tertiary care teaching hospital in Puducherry. Approval for the study was obtained from the Institutional Ethical Committee and written informed consent from each patient was taken before the study.

Results: The majority of cases within our study were within the age group of 41 to 60 years. In our study, the incidence of mediastinal lesions in males is 63%, while in females it is 37%. In our study among benign cases, constituting 41.7% of patients, tuberculosis was the primary ailment (56%), followed by sarcoidosis (36%) and reactive lymphadenitis (8%). Malignant diagnoses were evident in half of the patients (50%), with primary lung cancer being the most common (53.3%), followed by secondary metastasis to the lung (23.3%). Hodgkin’s lymphoma and non-Hodgkin’s lymphoma were each identified in 6.7% of patients, while 8.3% of cases were deemed non-diagnostic. EBUS-TBNA exhibited a diagnostic yield of 100% for mediastinal masses, whereas for lymphadenopathy cases, the procedure achieved a diagnostic rate of 91%.

Conclusion: Our study has shown that the EBUS-TBNA had a diagnostic yield of 91.7% in mediastinal lesions with 91% in mediastinal lymphadenopathy and 100 % in mediastinal mass. Hence, we conclude that the EBUS-TBNA far surpasses alternate modalities, making it a superior diagnostic tool for evaluating mediastinal lesions.