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A4157
October 27, 2015
1:00:00 PM - 3:00:00 PM
Room Hall B2-Area B
Does Airway Type Affect Endobronchial Ultrasound-Guided and Electromagnetic Navigational Transbronchial Needle Aspiration Diagnostic Yield?
Richard E. Galgon, M.D., M.S., Joseph C. Lawton, B.A., Scott Ferguson, M.D.
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin , United States
Disclosures: R.E. Galgon: B. Ownership; Self; STELA Medical, LLC. D. Equity Position; Self; STELA Medical, LLC. G. Consulting Fees; Self; CardioMed Device Consultants, LLC, Quintiles Consulting. J.C. Lawton: None. S. Ferguson: F. Funded Research; Self; Pulmonx, PneumRX, Pinnacle Biologics, Veracyte, Boston Scientific. G. Consulting Fees; Self; Uptake Medical, Allegro Diagnostics, Sanovas.
Introduction

Traditionally, mediastinoscopy is used for tissue sampling for staging lung cancer and diagnosing other mediastinal lesions. However, transbronchial needle aspiration (TBNA), guided by endobronchial ultrasound (EBUS-TBNA) or electromagnetic navigational systems (ENB-TBNA), is increasingly being favored.[1,2]

Airway management for these procedures has been successful using both tracheal tubes (TTs) and supraglottic airway (SGA) devices. Unlike an SGA, a TT lies below the vocal cords, which limits access to proximal (level 2) lymph nodes/lesions. Further, its longer length (32cm vs. 23cm) and smaller internal diameter (8-8.5mm vs. 11-12mm) subjectively impacts bronchoscope maneuverability, which may limit scope/biopsy target apposition. As such, SGA versus TT use may impact procedural diagnostic yield. However, no study has yet attempted to answer this question. Thus, the purpose of this study was to answer the question: Does airway type (TT vs. SGA) affect TBNA diagnostic yield?

Methods

After IRB approval, charts of patients who underwent EBUS- or EBN-TBNA under general anesthesia between 2009 and 2014 were reviewed. Patients hospitalized within 24 hours before the index procedure, those already intubated, and those undergoing other planned procedures during the same anesthetic were excluded. Patient, procedure, and anesthetic characteristics, diagnostic yield, and complications were extracted and analyzed. Intergroup comparisons were performed using unpaired t and Fisher's exact tests. P-values < 0.05 were considered significant.

Results

From 580 encounters, 437 records were analyzed after exclusions. TTs and SGAs were used in 46% and 54% of cases, respectively. Group age, gender, ASA physical status, body mass index, a priori selected co-morbidities, home CPAP and oxygen use, and anesthetic and procedure type were well-balanced between patients receiving TTs and SGAs (Table 1).

Group performance and outcome data are shown in Table 2. Diagnostic yield, home discharge, procedure and post-procedure complication, and 30-day re-hospitalization and all-cause mortality rates were similar. SGA use was associated with less frequent paralytic drug (PD) use and a shorter overall recovery time. The SGA-to-TT conversion rate was low.

Conclusions

From this retrospective study, airway type does not appear to impact TBNA diagnostic yield, suggesting either device type can be used. SGA use does favor less frequent PD use and a shorter recovery time, but will occasionally require SGA-to-TT conversion. Complications and 30-day re-hospitalization and all-cause mortality appear unaffected.

References. (1) Medford ARL, Int J Clin Pract, 2010; 64: 1773-1783; (2) Vaidya PJ et al, J Can Res Ther 2013;9:549-51
Figure 1
Figure 2

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