Diagnostic Value Of Video-assisted Mediastinoscopy And Endobronchial Ultrasound-guided Transbronchial Needle Aspirationfor Mediastinal Lymphadenectasis Without Pulmonary Abnormalities

Objective Mediastinal diseases are difficult to diagnose due to diverse origins and complex anatomical structure of the mediastinal tissues.There is lack of studies on benign mediastinal lesion andmediastinal lesions without pulmonary abnormalities.The objective of this prospective study was to compare two diagnostic techniques,video-assisted mediastinoscopy(VAM)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)for mediastinal lesion without pulmonary abnormalities.Method 100 mediastinal lymphadenectasis patients without pulmonary abnormalities were included according to inclusion criteria and randomly divided into two groups.Later,they were numbered by time of hospitalization,in whom,50 cases with odd numbersreceived VAM(VAM group)and 50 with even numbers underwent EBUS-TBNA(EBUS group).The results of the pathological diagnoses were regarded as the endpoints of this study.SPSS19.0 statistical software was adopted;enumeration data were expressed by rate(%)and compared using χ2test;measurement data was presented as (?)±s and were compared by t test.P< 0.05 was considered statistical significant.The sensitivity,specificity andaccuracy between the two diagnostic techniques were compared,and the category distribution of this disease and the risk factors for identification of benign and malignant lesions were explored.Results The operations of both groups were successfully completed,and no death and severe complications were observed.Among 100 patients,27 presented with malignant lesions,including 12 cases of small cell cancer,7 adenocarcinoma,4 squamous carcinoma and 4 ymphoma;while 73 exhibited benign lesions,including 28 tuberculosis,26 sarcoidosis,9 reactive hyperplasia,3 bronchogenic cysts,1 lymph cyst,1thymoma and 5 lymphnoditis.Among mediastinal lymphadenectasis patients without pulmonary abnormalities,there was no statistical difference in the identification of benign and malignant lesions and patients’ sex,age,smoking history with presence or absence of accompanied clinical symptoms(P> 0.05).The diagnostic accuracy,sensitivity and specificity of VAMwas 96%,97.4% and 100% respectively,while the value of EBUS-TBNAwas 62%,87.1% and 100%,respectively.In addition,the difference had no statistical significance in the diagnostic sensitivity of malignant mediastinal lesions between the two groups(P> 0.05),but it was significant in the diagnostic sensitivity of benign mediastinal lesions(P< 0.01).Compared with EBUS group,the sensitivity of VAM group was higher(97.4% vs.87.1%)(P> 0.05),and the accuracy was significantly higher(96% vs.62%)(P< 0.01).Conclusion a)In mediastinal lymphadenectasis patients without pulmonary abnormalities,the incidence of benign tumor may be higher than that of the malignant,but further studies are required.b)The diagnostic efficiency between VAM and EBUS for malignant mediastinal disease have no statistical difference.c)The diagnostic efficiencyof VAM for benign mediastinal disease is superior to that of EBUS.c)The sensitivity of VAMis higher than that of EBUSwithout a statistical significance,which may be attributed to small sample size.Thus,further study with larger sample size is required.e)The accuracy of VAM is obviously higher than that of EBUS.In summary,it is believed that the diagnostic value of VAM for mediastinal lymphadenectasis without pulmonary abnormalities is superior to that of EBUS.Therefore,for mediastinal lymphadenectasis or mediastinal mass patients without pulmonary abnormalities,mediastinoscopy as the first choice is recommended.