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Cost effectiveness of transbronchial needle aspiration: RESULTS (2)

The positive TBNA result altered further management in 22 of the 40 patients with malignant disease and one of two patients with benign disease. In the remaining 18 patients with malignancy, management was not altered because the tumours were deemed surgically unresectable for reasons including tumour cell type (small cell carcinoma), tumour stage or concurrent medical condition. In the authors’ opinion, positive TBNA obviated the need for 15 mediastinoscopy procedures, two thoracotomies and several other procedures, with these procedures summarized in Table 3. Table 4 gives the estimated cost of these procedures. Negative aspirates: Fifty-four patients had negative TBNA. Three of these patients had a second negative TBNA. Eight patients with negative TBNA underwent cervical mediastinoscopy, and in all cases, the nodes were negative for malignancy and presumed to be benign reactive lymphadenopathy. Ultimately, three of these eight patients had bronchogenic carcinoma, one had lymphoma and four had a benign condition. Four patients with negative TBNA underwent thoracotomy, one of whom also had a mediastinoscopy, and no malignant nodes were identified. One of these patients had bronchogenic carcinoma. Forty-two patients were followed medically; one of whom was lost to follow-up. Twelve patients had inoperable bronchogenic carcinoma, one patient had a history of prior bronchogenic carcinoma with new mediastinal adenopathy, seven had a nonlung primary malignancy, 21 patients had benign disease and one had a thyroid mass. No complications related to TBNA were documented. Chest radiographs were not routinely performed following the procedure.

Table 3. Procedures avoided by positive transbronchial needle aspiration

Procedure N
Mediastinoscopy 15
Thoracotomy 2
Transthoracic needle aspiration 1
Repeat bronchoscopy 1
Liver biopsy 3
Adrenal biopsy 1
Total 23

Table 4. Total cost of procedures avoided by transbronchial needle aspiration (TBNA)

Procedure N Cost/unit($) Total cost ($)
Mediastinoscopy 15 1,097 16,453
Thoracotomy 2 4,570 9,141
Transthoracic needle 1 271 271
aspirate
Bronchoscopy (no TBNA) 1 343 343
Liver biopsy 3 316 949
Adrenal biopsy 1 178 178
Total 23 27,335
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