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Aim: Little is still known regarind the impact of anesthesia on efficacy of EBUS-TBNA, EUS-b-FNA and EUS-FNA. Methods: 87 pts (53 males) referred for endosconography for mediastinal adenopathy were included. Total number of needle passes reached 187. Type of procedure, type of anesthesia, cytology quality and procedure duration were assessed. Results: Mean procedure diration for EUS-b-FNA was 9 min, reaching 7 min with local anesthesia and 13 min under sedation. For EUS-FNA, the same parameters were 15, 14, and 20 min, respectively. For EBUS-TBNA, the same data were 24, 14 and 20 min respectively. For EBUS-TBNA, representative metherial was retrieved in 77% of passes under local anesthesia, in 57% under sedation, and in 100% under generalanesthesia. For EUS-FNA, representative smears were obtained in 80% under local anesthesia, 60% under sedation, and 100% under general anesthesia. For EUS-b-FNA, the same data were 78%, 30%, and 83% respectively. In total, 79%, 44% and 96% of passes were representative for local anesthesia, sedation, and general anesthesia respectively. Conclusion: Different types of anesthesia during endosonography have a distinct impact on quality of cytology smears obtained in procedure. Independently from procedure type, and surpisingly, sedation led to lower quality of smears.

Background: Despite a rapid growth of EBUS-TBNA, cTBNA is still an option for almost all patients with mediastinal adenopathies. Aim: To evaluate efficacy of cTBNA in a tertiary-care hospital comparing efficacy of routine cytology in host institution and highly experienced cytopathologist in reference hospital. Methods: 44 pts with malignant and benign mediastinal adenopathy were enrolled, all undergone flexible bronchoscopy in local anesthesia with cTBNA performed using 21G dedicated needle (Boston Scientific Excelon). Smears were sent to ordinary cytologist, and afterwards were re-checked by an expert. Quality of smears, and diagnostic yield were compared between two sites and subgroups (malignancy/benign disease). Results: Among 44 pts, 10 cases were diagnosed as sarcoidosis, 34 - as lung cancer. According to local cytology, only 3/10 cases with benign disease were diagnostic, all the rest did not show any signs of lymphnode. For malignancy, 15/34 cases were diagnostic, and 16/34 described as representative of a limphnode. After re-check by an expert, 8/10 of benign cases were representative, among them 6 were diagnostic (60% efficacy). For malignancy, 25/34 cases were representative, among them 18 were diagnostic. Conclusion: Level of expertise for cytopathologist is of crucial importance in assessment of cTBNA smears. Re-check of cytology slides by an expert can improve diagnostic yield in benign mediastinal adenopathy by factor two. For malignancy, increase of the yield is a bit less, but still substantial.