Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSTUESDAY AFTERNOONMAY 12, 20092:00 p.m. SIMULTANEOUS SCIENTIFIC SESSION –GENERAL THORACIC SURGERYRoom 312, Hynes Convention Center(8 minutes presentation, 12 minutes discussion)Moderators: Nasser K. AltorkiShaf Keshavjee41. Endobronchial Ultrasound-Guided Fine-Needle Aspiration ofMediastinal Lymph Nodes: The Thoracic Surgeon’s PerspectiveShawn S. Groth, Natasha M. Rueth, Jonathan D’Cunha, * Michael A. Maddaus, *Rafael S. AndradeSurgery, University of Minnesota, Minneapolis, MN, USAInvited Discussant: Hiran C. FernandoOBJECTIVE: To assess our results with endobronchial ultrasound-guided fineneedleaspiration (EBUS-FNA) of mediastinal lymph nodes (MLNs) and todescribe the number and types of additional procedures we performed in the sameanesthetic setting as EBUS-FNA.METHODS: We performed an Institutional Review Board-approved review of ourprospectively maintained database of all patients who underwent EBUS-FNA ofMLNs by thoracic surgeons at our institution from September 1, 2006 throughSeptember 30, 2008.We included patients in our analysis if (1) EBUS-FNA cytology revealed malignancyor (2) non-malignant cytology (normal lymph node, benign pathology, ornondiagnostic samples) was verified with a confirmatory procedure (i.e., mediastinoscopy,thoracoscopy, or thoracotomy) that sampled the same MLN stations assampled by EBUS-FNA. We excluded the 10 initial procedures required to overcomeour learning curve. These criteria ensured the most accurate representationof our sensitivity, specificity, negative predictive value (NPV), positive predictivevalue (PPV), and accuracy.RESULTS: Over the study period, 166 patients underwent EBUS, 155 with FNA.Of these, 77 met our inclusion criteria. We report a sensitivity of 91.1%, a specificityof 96.8%, a NPV of 88.2%, a PPV of 97.6%, and a diagnostic accuracy of 93.4%.We performed an additional procedure in 59% of patients in the same anestheticsetting as EBUS-FNA: 41% underwent a diagnostic procedure (mediastinoscopy* AATS Member172
AMERICAN ASSOCIATION FOR THORACIC SURGERY[21%], endoscopic ultrasound-guided FNA [11%], thoracoscopy [9%], thoracotomy[0.2%]) and 35% underwent a therapeutic procedure (pulmonary resection[23%], tracheostomy [5%], intravenous port placement [5%], gastrostomy tubeplacement [4%], and pleurodesis [1%]).CONCLUSION: Thoracic surgeons can perform EBUS-FNA with excellentresults and have the distinct ability to combine EBUS-FNA with additional diagnosticand therapeutic procedures in a single anesthetic setting. EBUS-FNA addsto the thoracic surgeon’s unique capacity to expedite diagnostic work-up and treatmentthereby streamlining patient care.TUESDAYAfternoon173
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