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Cost effectiveness of transbronchial needle aspiration: DISCUSSION (2)

In 1998, Katis et al reported a prospective study involving 76 patients with chest radiographs suggestive of lung cancer and with evidence of mediastinal adenopathy on CT. Cytological examination of TBNA was positive for malignancy in 72% of patients.
In the present study, 40 of 56 patients with bronchogenic carcinoma had a positive TBNA, a yield of 71%. All patients had significant mediastinal or hilar adenopathy, or both, on CT scan, and patients with suspected small cell carcinoma or metastatic disease were not specifically excluded.

Positive TBNA obviated the need for further diagnostic procedures in 23 patients. The cost of these procedures was estimated at $27,335 versus $8,405, the cost of adding TBNA to the 99 bronchoscopy procedures. Additional costs include the TBNA needle and procedure time. One could argue that the liver and adrenal biopsies might have been done before the initial bronchoscopy because they may have provided both a diagnosis and stage. Excluding these procedures, the cost savings remain significant at $17,802.

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