RESUMO
BACKGROUND: The diagnostic yield of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) over a 3-year period was analyzed. METHODS: Consecutive patients who underwent EBUS for the evaluation of pulmonary/mediastinal lesions were recruited. RESULTS: One hundred and ninety-one patients were studied (54% male, mean age, 65 years [standard deviation 11.1]). A final diagnosis of a malignant disorder was made in 151 patients (79%). Of these, EBUS-TBNA alone provided the diagnosis in 135 patients. The majority of the remaining 56 patients had reactive changes (n = 32). Nineteen patients, either because they did not respond to appropriate treatment or based on clinical indication, underwent a different procedure resulting in an additional diagnosis of malignancy in 16 patients, tuberculosis in one and indeterminate in two. The diagnostic yield of EBUS for malignant disorders was 70.7% (95% confidence interval (CI), 0.86, 0. 77). The overall ability of EBUS to achieve a definitive diagnosis (benign plus malignant) was 90.1% (95% CI, 0.85, 0. 94). Logistic regression and stepwise regression analysis revealed that older age, greater lymph node size, and the presence of intraprocedure complications significantly influenced EBUS yield for malignancy. CONCLUSION: EBUS-TBNA has a high diagnostic yield for mediastinal lesions, both benign and malignant. The yield depends on both lesion- and patient-related factors.
RESUMO
BACKGROUND AND OBJECTIVE: Pleural effusion of undetermined etiology (PEUE), where blind pleural aspirate/biopsy fails to yield an answer, often needs histologic study for a definitive diagnosis. Several studies have shown the potential utility of medical thoracoscopy (MT) in PEUE; results, however, are not uniform and a majority are available for rigid thoracoscopy. We sought to determine the diagnostic accuracy of the relatively new technique of semirigid thoracoscopy in PEUE through this systematic review. METHODS: The electronic search was carried out in PubMed without language restriction. References of relevant records and abstracts were hand searched. Articles were selected based on the following criteria: (1) prospective study, (2) based on original research, (3) enrolled consecutive patients with PEUE, (4) full paper available in English, (5) MT carried out under local anesthesia (LA) using semirigid (flex-rigid) instrument, and (6) reported sufficient data to construct a 2∞2 contingency table. We assessed the study quality and extracted data independently and in duplicate using a standardized data extraction form. RESULTS: Five studies met the inclusion criteria, encompassing 154 patients. Pooled sensitivity (95% CI) was 0.97 (0.92-0.99), specificity (95% CI) was 1.00 (0.69-1.00), positive likelihood ratio (95% CI) was 5.47 (1.11-16.86) and negative likelihood ratio (95%CI) was 0.08 (0.04-0.18). No major complications or mortality was noted. CONCLUSION: Semirigid thoracoscopy seems to be a safe, simple, and accurate tool for undiagnosed pleural effusions. It is well tolerated and is devoid of major complications. Further studies with sound methodology will further help to define the future role of this procedure.
RESUMO
BACKGROUND: The utility of the recently introduced semirigid thoracoscopy in undiagnosed pleural effusions is still unclear. METHODS: A single-center, 4-year retrospective analysis of all semirigid medical thoracoscopy procedures was done. The diagnostic accuracy of thoracoscopy was calculated as the number of positive diagnoses achieved by thoracoscopy in relation to the end-diagnosis achieved in the patient group by any means. RESULTS: One hundred fifty procedures were analyzed. Ninety-two patients (62.3%) were diagnosed as having a malignant disorder, of which mesothelioma was the most common (26%). Pleural thickening and nodularity were the most common abnormalities noted. The combined presence of nodules and hemorrhagic fluid increased the likelihood of malignancy 9-fold. Thirteen patients with a high clinical suspicion of malignancy but negative by thoracoscopy underwent mediastinoscopy, computed tomography-guided biopsy, or open thoracotomy. A malignant etiology was confirmed in all of them. Overall, thoracoscopy provided a diagnostic accuracy of 91.3%, sensitivity of 87%, and specificity of 100%. The addition of a second procedure in selected patients improved the diagnostic accuracy for malignancy by 8.7%. The procedures were well tolerated and only 6 patients developed minor and transient complications such as pain, hypoxia, and bradycardia. CONCLUSION: Semirigid thoracoscopy is a safe, well-tolerated, and efficacious procedure for establishing the diagnosis in pleural effusions of undetermined etiology.