Ultrasound-guided transbronchial needle aspiration complication rate ‘reassuring’

Multisite findings support the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS‑TBNA) for mediastinal lymph node sampling.

Data from the American College of Chest Physicians Quality Improvement Registry, Evaluation and Education database for 1317 patients who underwent EBUS‑TBNA at one of six US hospitals between February 2009 and August 2010 indicate that complications occurred in just 1.44% of patients.

"It shows that EBUS‑TBNA is a reassuringly safe procedure," say George Eapen (University of Texas MD Anderson Cancer Center, Houston, USA) and co-authors in Chest.

However, patients were a significant 2.85 times more likely to experience complications if they also underwent transbronchial lung biopsy compared with EBUS‑TBNA alone (3.21 vs 1.14%).

Furthermore, patients attending hospitals using rapid on-site cytologic evaluation (ROSE) were significantly less likely to undergo biopsy than those attending institutes without this facility (12.6 vs 19.1%).

Of concern, there was a significant variation in the use of both ROSE and transbronchial lung biopsy between the hospitals in the study, the team notes.

"Future studies should expand this registry to other hospitals of varying sizes and more diverse practice patterns to verify these findings and to begin to explore the interactions between hospital level and physician level variations on complications and their consequences," Eapen et al suggest.

Nevertheless, just 0.53% of patients experienced pneumothorax and 1.06% of patients required escalation in their level of care. Escalation was significantly associated with age over 70 years (OR=4.06), inpatient status (OR=4.93), and requirement of deep sedation or general anesthesia (OR=4.68)

Other complications occurring too infrequently to allow analysis included sustained hypoxia (n=4), bleeding requiring intervention (n=3), respiratory failure within 24 hours of EBUS‑TBNA (n=3), hypotension (n=1), and clinically significant airway damage (n=1).

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