Electromagnetic navigation‐guided TBNA vs conventional TBNA in the diagnosis of mediastinal lymphadenopathy

Objectives Conventional transbronchial needle aspiration ( C‐TBNA ) is a safe method for the diagnosis of hilar and mediastinal lymphadenopathy ( MLN ). However, diagnostic yield of this technique varies considerably. Electromagnetic navigation bronchoscopy ( ENB ) is a new technology to increase the diagnostic yield of flexible bronchoscopy for the peripheral lung lesions and MLN . The aim of this prospective study was to compare the diagnostic and sampling success of ENB ‐guided TBNA ( ENB‐TBNA ) in comparison with C‐TBNA while dealing with MLN . Methods Consecutive patients with MLN were randomized into two groups – C‐TBNA and ENB‐TBNA – using a computer‐based number shuffling system to avoid recruitment bias. Procedures were performed in usual fashion, published previously. Results Ninety‐four cases (M/F: 45/49) with a total of 145 stations of MLN were enrolled in the study. In 44 patients, 81 stations were sampled by ENB‐TBNA , and in 50 patients 64 stations by C‐TBNA . The mean size of MLN in study subjects was 17.56 ± 6.25 mm. The sampling success was significantly higher in ENB‐TBNA group (82.7%) compared with C‐TBNA group (51.6%) ( P  < 0.005). Defined by histopathological result, the diagnostic yield in ENB‐TBNA was 72.8%, and 42.2% with C‐TBNA ( P  < 0.005). For subcarinal localization, sampling or diagnostic success was higher in ENB‐TBNA than that of C‐TBNA ( P  < 0.05). Based on the size of the MLN ≤15 mm or >15 mm, the sampling success of ENB‐TBNA was also significantly higher than C‐TBNA in both subgroups ( P  < 0.005 and P  < 0.005, respectively). No serious complication was observed. Conclusion In this study comparing ENB‐TBNA and C‐TBNA , the sampling and diagnostic success of ENB‐TBNA was found to be superior while dealing with MLN , in all categories studied.