Jain et al performed a cost analysis on a hypothetical cohort of 1000 patients with mediastinal lymphadenopa-thy. The patients underwent either initial bronchoscopy with TBNA, followed by mediastinoscopy if the TBNA was negative (strategy A) or mediastinoscopy without TBNA (strategy B). They calculated a cost savings of US$1.67 million/1000 patients by using strategy A.
TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic carcinoma. The ability to diagnose and stage patients at the time of initial bronchoscopy simplifies patient management in a cost effective manner. This study supports the findings of Turner and Wong in recommending sequential use of CT and TBNA in the investigation of patients with suspected lung cancer. The yield of TBNA with a cytology needle is much lower for benign disease, and consideration should be given to using a histology needle when a benign process is suspected.