DIAGNOSTIC UTILITY OF LINEAR EBUS-TBNA IN CENTRALLY LOCATED LUNG TUMORS AND MEDIASTINAL LYMPHADENOPATHY
Main Article Content
Keywords
Linear EBUS-TBNA, Centrally located lung tumors, Mediastinal lymphadenopathy, Lung cancer diagnosis, Mediastinal staging, Endobronchial ultrasound, Diagnostic yield
Abstract
Centrally located lung tumors and mediastinal lymphadenopathy pose diagnostic challenges, especially when conventional bronchoscopy yields inadequate samples. Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) enables real-time sampling of mediastinal and hilar lymph nodes with high diagnostic accuracy. This study evaluates the diagnostic performance, staging utility, and safety of linear EBUS-TBNA in patients with central lung lesions and mediastinal lymphadenopathy.
Methods: A hospital-based cross-sectional observational study was conducted over five months in the Department of Respiratory Medicine, TB & Chest Hospital, Udaipur. A total of 38 patients ≥18 years with centrally located lung tumors or mediastinal lymphadenopathy were enrolled. Patients underwent clinical evaluation, chest radiography, CECT thorax, fibreoptic bronchoscopy, and EBUS-TBNA. Data on demographics, clinical features, radiology, lymph node characteristics, sampling details, histopathology, and complications were analyzed. Diagnostic performance was calculated using sensitivity, specificity, and predictive values. Statistical significance was set at p < 0.05.
Results: Of the 38 patients, 30 were diagnosed with lung carcinoma (24 NSCLC, 6 SCC). The mean age was 63.23 years, and 76.7% were male. Cough (83.3%), hemoptysis (53.3%), and weight loss (53.3%) were the most common symptoms. CECT most frequently identified masses in the right lower lobe (20%), while mediastinal nodes were common at stations 7 (23.3%) and 10R (20%). EBUS-TBNA most frequently sampled station 7 (23.3%). Single-node sampling was performed in 63.3% of cases. Histopathology confirmed NSCLC in 80% and SCC in 20%. EBUS-TBNA demonstrated a diagnostic yield of 84.2%, significantly higher than bronchoscopy (21.1%). Sensitivity, specificity, PPV, and NPV for diagnosing malignancy were 88.8%, 100%, 100%, and 33.3%, respectively. Most patients presented in stage IIIA/IIIB (63.3%). Procedure-related complications were minimal (16.6%), consisting mainly of minor bleeding and mild desaturation, with no major adverse events.
Conclusion: Linear EBUS-TBNA is a highly effective and safe diagnostic modality for centrally located lung tumors and mediastinal lymphadenopathy, offering superior diagnostic yield over bronchoscopy. Its ability to provide simultaneous diagnosis and staging supports its role as a first-line invasive investigation in lung cancer evaluation.
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Dr Sarthak Jindal
Post Graduate Student, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Mahesh Kumar Mahich
Assistant Professor, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Neha Damor
Assistant Professor, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Mahendra Kumar Bainara
Senior Professor, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Archana MK
Post Graduate Student, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Nemi Chand Garg
Post Graduate Student, Department of Respiratory Medicine, RNT Medical College, Udaipur, Rajasthan, India
Dr Jatin Prajapati
Senior Resident, Department of Community Medicine, World College of Medical Sciences and Research, Jhajjar, Haryana, India, ORCID: https://orcid.org/0009-0004-7298-4499
