Diagnostic performance and complications of 396 EBUS-TBNA procedures performed under bronchoscopist-directed conscious sedation

The type of sedation for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is a relevant issue. Optimal sedation contributes to optimizing both the EBUS-TBNA performance and the cost of care. Our study aims to assess the diagnostic performance and complications of EBUS-TBNA performed under bronchoscopist-directed conscious sedation.

We retrospectively analysed the data of 396 consecutive patients [male, 75%; mean age 64±16 years (range 24-89)] who underwent EBUS-TBNA of suspected mediastinal lymph nodes during conscious sedation, with midazolam (mean dose, 3.5±1.1 mg) and fentanyl (mean dose, 0.015±0.001 mg) and with spontaneous breathing. Samples' rapid on-site evaluation was not done. In order to define EBUS-TBNA accuracy, aspirate cyto-histological findings were compared to lymphadenectomy results, or to radiological findings at one-year follow-up in non surgical cases.

We sampled 532 lymph nodes [mean number of passes/node, 3±1; lymp node mean size, 1.9±1.4 cm (range 1.0-6.0)]. The procedure mean duration was 22±8 (range 8-65) minutes. EBUS-TBNA samplings were adequate for pathology interpretation in 363 (92%) cases. In 135 cases the diagnosis was malignant disease, in 43 granulomatous disease, in 185 normal lymph node. EBUS-TBNA diagnostic accuracy was 95%. Peri-procedural morbidity rate was 1.5% (6 minor, self-limited complications); mortality was nil.

In conclusion, EBUS-TBNA under bronchoscopist-directed conscious sedation was a safe procedure, with high diagnostic accuracy, and averted general anaesthesia costs and risks.