Efficacy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Mediastinal and Hilar Lesions

Abstract

Background: Mediastinal and hilar lesions may be benign or malignant. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis of these lesions as it is both minimally invasive and safe. Objective: To investigate the clinical efficacy of EBUS-TBNA in the diagnosis and differential diagnosis of mediastinal and hilar lesions. Methods: A retrospective observational study was undertaken to investigate patients diagnosed with mediastinal and hilar lymphadenopathy based on imaging at our hospital from 2020 to 2021. After evaluation, EBUS TBNA was used and data including the puncture site, postoperative pathology, and complications were recorded. Results: Data from 137 patients were included in the study, of which 135 underwent successful EBUS TBNA. A total of 149 lymph node punctures were performed, of which 90 punctures identified malignant lesions. The most common malignancies were small-cell lung carcinoma, adenocarcinoma, and squamous cell carcinoma. Forty-one benign lesions were identified, resulting from sarcoidosis, tuberculosis, and reactive lymphadenitis, amongst others. Follow-up findings showed that 4 cases were malignant tumors, with 1 case of pulmonary tuberculosis and 1 case of sarcoidosis). Four specimens where lymph node puncture was insufficient were subsequently confirmed by other means. The sensitivity of EBUS TBNA for malignant lesions, tuberculosis and sarcoidosis in mediastinal and hilar lesions was 94.7%, 71.4%, and 93.3%, respectively. Similarly, the negative predictive values (NPV) were 88.9%, 98.5%, and 99.2%, and the accuracy was 96.3%, 98.5%, and 99.3%. Conclusion: EBUS TBNA is an effective and feasible approach for the diagnosis of mediastinal and hilar lesions that is minimally invasive and safe.