Abstract
Introduction: Morphological evaluation of lymph node is essential for diagnostic confirmation and treatment planning of patients (pts) with mediastinal lymphadenopathy. EBUS-TBNA and EUS-FNA are minimally invasive procedures that provides material for the cytological workup. However it could be difficult to select the order of preference if both of the techniques are available. Aims and methods: The aim was to determine the diagnostic value of EBUS-EUS combined approach by using single ultrasound bronchoscope for evaluation mediastinal lymphadenopathy. EUS-FNA and EBUS-TBNA (Olympus Exera II BF-UC160F, Olympus 21g needles) were compared in 166 patients for tissue diagnosis from enlarged (more than 0.9 cm) 7 and 4L group lymph nodes. 110 lesions were sampled from the respiratory tract under moderate sedation as the first step and 56 lesions were biopsied initially from the esophagus under local anesthesia. Rapid on-site evaluation of the aspirates was used. In cases when primary EUS-FNA (8 pts) showed no diagnostic results EBUS-TBNA was performed. Results: Definitive morphology diagnosis was made in 87,3% of pts in EBUS-TBNA group and in 85,7% of pts in EUS-FNA group, and in 96,4% of pts by the combined approach with rapid on-site evaluation. Conclusion: EUS-FNA and EBUS-TBNA can be performed with single ultrasound bronchoscope and combine approach with rapid on-site evaluation has better diagnostic value than either alone. But EUS-FNA with ultrasound bronchoscope is easy, safety and does not requre sedation. Therefore it could be used for tissue diagnosis of enlarged 7 and 4L group lymph nodes as first step of examination.
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