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Vol. 44. Issue 6.
Pages 290-294 (January 2008)
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Vol. 44. Issue 6.
Pages 290-294 (January 2008)
Original Articles
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Transbronchial Needle Aspiration in the Study of Mediastinal Lymph Nodes: Yield and Cost-Effectiveness
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Pilar Martínez-Olondrisa, María Molina-Molinaa, Antoni Xaubeta, Ramón María Marradesa, Patricio Luburichb, José Ramírezc, Antoni Torresa, Carlos Agustía,
Corresponding author
cagusti@clinic.ub.es

Correspondence:Dr C. AgustíServei de Pneumologia, Hospital Clínic Villarroel, 17008036 Barcelona, Spain
a Servei de Pneumologia, Institut Clínic del Tòrax, IDIBAPS, Hospital Clínic, CIBER Enfermedades Respiratorias, Barcelona, Spain
b Servei de Radiodiagnòstic, Hospital Clínic, Barcelona, Spain
c Servei d'Anatomia Patològica, Hospital Clínic, Barcelona, Spain
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Objective

The role of different techniques formediastinal staging in patients with suspected lung cancer isa subject of debate. The aim of this study was to analyze the diagnostic yield and cost-effectiveness of transbronchialneedle aspiration in the mediastinal staging of lung cancerin patients being evaluated in a tertiary hospital.

Patients and methods

This was a retrospective, observational study of the results of transbronchial needleaspiration in patients with suspected lung cancer andmediastinal lymph node involvement. A cost-effectivenessanalysis of the systematic use of this technique was also performed.

Results

One-hundred ninety-four patients (85% men,15% women) were evaluated. The diagnosis of lung cancerwas confirmed in 157 (81%). Cytology samples obtained bytransbronchial needle aspiration were adequate in 147 (76%)of the 194 cases. When only the adequate samples wereincluded in the analysis, transbronchial needle aspirationshowed a sensitivity of 88%, specificity of 100%, positivepredictive value of 100%, negative predictive value of 64%, and efficiency of 90%. Mediastinoscopy was avoided in 44 (34%) of the 127 patients with localized non-small celllung cancer, with an estimated saving of €119 456.

Conclusions

Transbronchial needle aspiration has a highdiagnostic yield and obviates the need for mediastinoscopy ina significant percentage of cases. This finding is of diagnosticand economic significance.

Key words:
Lung cancer
Staging
Mediastinal lymph nodes
Fiberoptic bronchoscopy
Objetivo

Existe controversia sobre el papel de las dife-rentes técnicas diagnósticas en la estadificación del mediasti-no en pacientes con sospecha de cáncer de pulmón. El obje-tivo del estudio ha sido analizar la rentabilidad diagnósticay el coste-beneficio de la punción transbronquial aspirativa(PTA) en la estadificación mediastínica del cáncer de pul-món, en pacientes evaluados en un hospital de tercer nivel.

Pacientes y métodos

Se ha realizado un estudio obser-vacional retrospectivo, en el que se han analizado los resul-tados de las PTA practicadas a pacientes con sospecha decáncer de pulmón y adenopatías mediastínicas patológicas. También se ha evaluado el coste-beneficio de la aplicaciónsistemática de esta técnica.

Resultados

Se evaluó a 194 pacientes (un 85% varonesy un 15% mujeres), en 157 de los cuales (81%) se confirmóel diagnóstico de cáncer de pulmón. La muestra citológicaque se obtuvo de la PTA fue adecuada en 147 de los 194 ca-sos (76%). Cuando se analizaron las muestras adecuadas, lasensibilidad de la PTA fue del 88%, la especificidad del100%, el valor predictivo positivo del 100%, el valor predic-tivo negativo del 64% y el valor global del 90%. En 44 de los127 casos (34%) con cáncer de pulmón no microcítico locali-zado se evitó la realización de una mediastinoscopia, lo querepresentó un ahorro económico estimado de 119.456 €.

Conclusiones

La PTA es una técnica con una elevadarentabilidad diagnóstica que puede evitar la realización deuna mediastinoscopia en un porcentaje significativo de pa-cientes, con las consiguientes implicaciones terapéuticas yeconómicas que ello conlleva.

Palabras clave:
Cáncer de pulmón
Estadificación
Adenopatíasmediastínicas
Fibrobroncoscopia
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This study was partially financed by FUCAP-05 (Catalan Pneumology Foundation grant).

Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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