EBUS-TBNA procedure

The seventh edition of the classification of the International Association for the Study of Lung Cancer (IASLC) was used to define lymph node stations: 1, highest mediastinal; 2, upper paratracheal; 3, pre-vascular and retrotracheal; 4, lower paratracheal; 5, subaortic; 6, para-aortic; 7, subcarinal; 8, paraesophageal; 9, pulmonary ligament; 10, hilar; 11, interlobar; 12, lobar; 13, segmental; 14, subsegmental.

All patients signed an informed consent before EBUS-TBNA performance. The procedure was performed under conscious sedation with midazolam and nebulized local anaesthesia with lidocaine 1%-2% using a convex probe echo-endoscope (BF-UC160F/180FOL8; Olympus, Tokyo, Japan). Lymph nodes were sampled with a 21-gauge Olympus Vizi Shot single-use aspiration needle, as previously described⁸. Rapid-on-site cytologic evaluation was not performed. Histopathological and microbiological examination was performed. Direct examination for acid-fast bacilli using Ziehl–Neelsen staining and mycobacterial culture were performed in all cases. The Xpert MTB/RIF assay was performed only in case of positive microscopy for acid-fast bacilli. EBUS-TBNA was deemed as diagnostic, if it led to specific diagnosis (tuberculosis, malignancy, lymphoma, sarcoidosis, or others), or if it showed normal lymphatic tissue and a follow-up of at least one year confirmed stability or improvement in patient’s condition, ruling out false-negative result.