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Published ahead of print on January 21, 2005, doi:10.1164/rccm.200411-1560OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 10, May 2005, 1164-1167

A more recent version of this article appeared on May 15, 2005
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Submitted on November 22, 2004
Accepted on January 12, 2005

Transbronchial vs. Transesophageal Ultrasound-guided Aspiration of Enlarged Mediastinal Lymph Nodes

Felix JF Herth1, William Lunn2, Ralf Eberhardt1, Heinrich D Becker1, and Armin Ernst2*

1 Thoraxklinik, Department of Internal Medicine, Pneumology and Critical Care Medicine, University of Heidelberg, Heidelberg, Germany, 2 Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed. E-mail: aernst{at}bidmc.harvard.edu.

Rationale: Transesophageal and transbronchial, ultrasound-guided, fine-needle aspiration of enlarged mediastinal lymph nodes has become popular, but have never been compared directly. Objectives: To compare the relative diagnostic yield and ability of the transesophageal and transbronchial approaches to reach abnormal mediastinal lymph nodes. Methods: 160 patients with enlarged lymph nodes in one of 8 mediastinal lymph node stations underwent transbronchial and transesophageal biopsies in a crossover design. Each of the 8 stations was allocated 20 patients. Two needle punctures were done with each approach. Measurements: Percentage of successful biopsies, percentage of patients diagnosed, and biopsy time, measured from when the lymph node was identified with ultrasound. Main Results: Among the 106 men and 54 women (mean age, 53.2 years), transbronchial aspiration was successful in 85%, and transesophageal aspiration was successful in 78% (P=0.2). For each station, the number of positive samples for the transbronchial/transesophageal approaches was: 2R-19/13, 2L-16/19, 3-17/15, 4R-19/12, 4L-17/20, 7-19/20, 10R- 18/9, and 10L-17/18. Combining both approaches produced successful biopsies in 97% and diagnoses in 94% of patients. Mean biopsy times were 3.2 min for the transbronchial approach and 4.1 min for transesophageal approach. The transbronchial approach was superior in nodes 2R, 4R and 10R. No complications were encountered. Conclusions: In experienced hands, enlarged mediastinal lymph nodes may be aspirated with either the transbronchial or transesophageal approach. These techniques have similar diagnostic yields, although the transbronchial approach is superior for right-sided lymph nodes. Combining both approaches provides results similar those of mediastinoscopy
Key words: Endobronchial ultrasound, endoesophageal ultrasound, transbronchial needle aspiration, mediastinal lymphadenopathy, lung cancer




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