Diagnostic Yield of EBUS-TBNA
EBUS-TBNA has a pooled diagnostic accuracy of approximately 78-79% across various conditions, with higher yields for certain pathologies like tuberculosis (80-85%) and lower yields for lymphoma (69%).
Overall Diagnostic Accuracy
- EBUS-TBNA provides safe and minimally invasive access to mediastinal and hilar lymph nodes with a pooled diagnostic accuracy of 79.1% across various conditions 1
- A systematic review and meta-analysis including 15 studies with 553 patients showed diagnostic yields ranging from 54% to 93%, with a pooled accuracy of 79% (95% CI, 71-86) 1
- When additional studies were included (total of 25 studies with 1,126 patients), the pooled diagnostic accuracy was 78.2% (95% CI, 75.6-80.4) 1
Disease-Specific Diagnostic Yields
Sarcoidosis
- For suspected sarcoidosis with mediastinal/hilar adenopathy, EBUS-TBNA is recommended with Grade 1C evidence 1
- EBUS-TBNA had a yield of 74.5% for sarcoidosis, which was significantly better than conventional TBNA (48.4%, p=0.004) and endobronchial biopsy (36.3%, p<0.0001) 1
- Combining EBUS-TBNA with transbronchial lung biopsy (TBLB) significantly enhances the diagnostic yield 1
Tuberculosis
- For suspected tuberculosis with mediastinal/hilar adenopathy, EBUS-TBNA is recommended with Grade 1C evidence 1
- Diagnostic yield for TB ranges from 79.2% to 84.8% across studies 1
- In TB-endemic populations, EBUS-TBNA achieved a high yield of 84.8% even during operators' early experience 1
Lymphoma
- EBUS-TBNA has a lower diagnostic yield for lymphoma compared to other conditions, with a pooled diagnostic accuracy of 68.7% (95% CI, 61.9-75.5) 1
- Diagnostic yield varies significantly between studies (38-91%), with higher yields for relapsed lymphoma compared to de novo lymphoma 1
- For suspected new cases of lymphoma, especially Hodgkin lymphoma, the diagnostic yield can be as low as 25-61% 2
- The diagnostic accuracy for lymphoma is affected by the need for histologic architecture assessment and immunophenotyping 1
Factors Affecting Diagnostic Yield
- Lymph node characteristics: Nodes ≤5mm in size and those in paratracheal locations have lower sampling accuracy 3
- Needle size: 19G, 21G, and 22G needles show similarly high diagnostic sensitivity (93%, 87.6%, and 85% respectively) 4
- Number of passes: Optimal diagnostic values can be obtained after a minimum of three passes per sampling site 1
- Rapid on-site evaluation (ROSE): No significant difference in diagnostic yield between procedures with ROSE (80.1%) and without ROSE (81.3%) 1
- Complementary techniques: Combining EBUS-TBNA with transbronchial forceps biopsy can improve diagnostic yield from 73% to 86%, particularly for granulomatous and lymphoproliferative disorders 5
Comparison to Other Techniques
- EBUS-TBNA (74.5%) shows superior diagnostic yield compared to conventional TBNA (48.4%) and endobronchial biopsy (36.3%) 1
- For lung cancer and mediastinal staging, EBUS-TBNA demonstrates high sensitivity (86.1-88.3%) and specificity (96.4-100%) 6, 3
- When sampling is limited to enlarged right paratracheal and subcarinal lymph nodes, EBUS-TBNA yield (74.5%) is comparable to transbronchial lung biopsy (69.9%) 1
Practical Considerations
- In the absence of rapid on-site evaluation, a minimum of 3 separate needle passes per sampling site is recommended for optimal diagnostic yield 1
- For molecular and immunohistochemical testing, 19G needles may provide better sample adequacy 4
- Operator experience affects diagnostic yield, with EBUS-STAT scores showing significant differences between beginners (31.1), intermediate (74.9), and experienced (93.6) bronchoscopists 1
- Airway distortion and lymph node calcification are associated with less accurate EBUS-TBNA results 3