Diagnostic accuracy, indications, and negative predictive value of EBUS-TBNA procedure: retrospective observational study from a referral cancer institute

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is minimally invasive procedure for the evaluation of mediastinal mass and lymph nodes. Aim: This study was conducted as an internal audit to determine diagnostic accuracy, false-negative rate of a costly, invasive procedure EBUS-TBNA performed under conscious sedation or deep/general anesthesia. Methods: Forty-nine patients who underwent EBUS-TBNA procedure at our institute were included in this retrospective study. Sensitivity, diagnostic accuracy, and negative predictive values were calculated considering clinical radiological assessment till 6 months as gold standard. Results: Forty-nine patients (27 females and 22 males) with mean age of 47.88 years underwent EBUS-TBNA during a period of 8 months. The most common indication was extrathoracic malignancy metastasis in 26 (53.1%) patients. EBUS-TBNA was performed for diagnosing malignancy lung in 11 patients, granulomatous disease in 8 patients, and mediastinal mass in 4 patients. A total of 74 nodes were sampled in 49 patients. Adequate samples were obtained in 46 patients (93.9%). Diagnostic accuracy was overall 91.8%. There were no procedure-related complications or mortality noted in any patient. Out of 17 negative cases, false negatives were 4, and negative-predictive value was 76.5%. The diagnostic accuracy, sensitivity, and negative predictive value were higher in procedures performed under deep sedation/general anesthesia. Conclusion: Diagnosing extrathoracic malignancy metastasis and malignancy lung are major indications for the EBUS-TBNA procedure at our institute. The diagnostic accuracy overall was 91.8%. The negative-predictive value, diagnostic accuracy, and sensitivity were higher for procedures performed under deep sedation/general anesthesia versus conscious sedation.