We report the results of a retrospective review of clinical cases after the implementation of an endobronchial ultrasound-guided fine needle aspiration biopsy (FNAB) protocol in a second level hospital. Interventions performed during a 16-month period, between November 2012 and February 2014, were included.

An anesthetist attended all interventions, which were performed using laryngeal mask, vital sign monitoring, electrocardiography and bispectral index. A pathologist was also available for rapid on-site cytological evaluation of the specimens, using hematoxylin staining or a Diff-Quik technique.

The overall series consisted of 25 patients, with a mean age of 58.5 years, ranging from 31 to 76 years. Twenty-two patients (88%) were men, so the population was predominantly male, and 88% were smokers, according to their clinical records.

The initial reason for requesting the test was diagnosis of suspected tumor disease in 56%, staging of cancer previously detected using other techniques in 16%, and to rule out sarcoidosis in 28%.

Mean lymphadenopathy size was 20.8mm, ranging between 10 and 40mm. Overall, 56% were located in region 7 (subcarinal), 40% in region 10 (hilar), 36% in region 11 (interlobar), 28% in region 4 (lower paratracheal), 8% in region 2 (upper paratracheal) and 4% in region 3p (retrotracheal). In 67.8% of cases, the site was on the right side.

The average number of passes for performing the puncture ranged between 1 and 7, with an average of 4 per patient. On-site cytological examination of lymph node FNAB was performed in 88% of cases, while puncture was unsuccessful in 3 patients.

Initial diagnoses were given for 36% of all specimens in which malignancy was suspected (staging specimens are included in this figure): 12% were granulomatous lymphadenitis and 40% atypical/reactive lymphadenitis or contamination with bronchial mucosa. Complications occurred on 1 occasion only (4%), when glottis edema led to discontinuation of the procedure.

Final diagnosis after deferred pathological analysis confirmed cancer in 6 patients (24%), positive staging in 3 (12%), sarcoidosis in another 3 (12%) and reactive lymphadenitis in 1 (4%).

A total of 9 (36%) patients had to be referred for chest surgery, 6 of which were confirmed as true negatives. False negatives included 2 cases of sarcoidosis and some rheumatoid nodules.

In summary, ultrasound-guided bronchoscopy is a rapid procedure that does not require hospitalization and is very beneficial from an anesthesiology point of view.1 This intervention is safe, major complications are rare,2 and diagnosis was achieved rapidly. Diagnostic yield from this technique is similar to that of mediastinoscopy, as widely reported in the literature.3 Another advantage is its non-aggressive nature. Moreover, since surgical procedures are obviated, savings in terms of operating and hospitalization costs are considerable.4

Despite the limited size of the series reported in this review, due to the small number of staff in our unit, and our initial lack of experience in conducting this procedure, it is interesting to note that an overall diagnostic yield of 72% was achieved, including the true negatives determined by chest surgery.

It should also be pointed out that in the on-site cytology evaluation, all cancers, including stagings, were detected.5