Background: A number of patients with radiologically suspicious chest tumors remain undiagnosed despite bronchoscopy or CT-guided fine-needle aspiration (CT-FNA). Such patients are often referred for mediastinoscopy, which is an invasive surgical procedure that poses a small but significant risk to the patient. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS) is a well-established method for mediastinal staging of lung cancer but may also be used as a diagnostic tool in patients with undiagnosed intrathoracic lesions.
Methods: During a 36-month period (January 2006 to December 2008), 601 patients underwent EBUS under general anesthesia. Two hundred ninety-three (293) patients had an established diagnosis of lung cancer and were referred to us for mediastinal staging. The remaining 308 patients had a radiologically suspicious lesion and had been investigated previously by CT and bronchoscopy, including brush cytology, but remained undiagnosed.
Results: Overall, EBUS was able to diagnose 55% of the 308 patients. Diagnostic yield was significantly higher in central parenchymal lesions (72%) compared with enlarged lymph nodes (54%) or peripheral lesions (43%) (P < 0.05). All patients were examined as outpatients and there was not a single complication in any patient.
Conclusions: EBUS is a valuable tool to diagnose chest lesions and yield depends on the anatomical location. We believe that EBUS should be the first choice for further workup in patients who remain undiagnosed after conventional CT and bronchoscopy because it is very safe, fast, and minimally invasive.