The impact of anesthesia methods and rapid on-site evaluation on the diagnosis of lung cancer using endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective study.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a critical method for diagnosing lung cancer. While EBUS-TBNA is commonly performed under conscious sedation, the potential benefits of conducting the procedure under general anesthesia and incorporating rapid on-site evaluation (ROSE) to enhance diagnostic yield remain uncertain. This study aims to investigate the impact of anesthesia methods and ROSE on the diagnostic efficacy of EBUS-TBNA for lung cancer.

Methods: This study collected data from patients who underwent EBUS-TBNA for suspected lung cancer in the Department of Respiratory and Critical Care Medicine at The Affiliated Hospital of Southwest Medical University from August 2018 to December 2023. Patients were categorized into three groups based on the anesthesia method used and whether ROSE was performed: the non-general anesthesia group (NGA group), the general anesthesia group (GA group), and the general anesthesia with ROSE group (RGA group). The study analyzed baseline characteristics, puncture details, diagnostic outcomes, and complications across the groups.

Results: The number of puncture needles used in the RGA group was significantly lower than in the other two groups (P<0.001). Most patients received a definitive diagnosis, with malignant tumor diagnostic rates of 80.95%, 85.71%, and 93.44% in the NGA, GA, and RGA groups, respectively (P=0.12). The overall disease diagnostic rates were 76.06%, 79.22%, and 86.11%, respectively (P=0.30). No severe complications occurred in any of the groups. The proportion of patients willing to undergo repeat EBUS-TBNA was significantly lower in the NGA group compared to the other two groups (P=0.002).

Conclusions: Compared to local anesthesia combined with intravenous analgesia and sedation or general anesthesia alone, general anesthesia combined with ROSE reduces the number of puncture needles required during EBUS-TBNA but does not further improve diagnostic efficacy.