OBJECTIVES :

Endobronchial ultrasound (EBUS) and mediastinoscopy are procedures that sample thoracic lymph nodes and diagnose and stage lung cancer. EBUS was introduced as a less invasive and less costly sampling method, and studies have shown similar diagnostic yield for the two procedures. Limited data exists on the real-world adoption of EBUS and its utilization trends compared to those for mediastinoscopy among the commercially insured. This study sought to examine procedure trends and rates of post-procedural pneumothorax, which is a clinically relevant complication.

METHODS :

Patients who underwent EBUS or mediastinoscopy were identified within the Truven MarketScan™ database (2009-2016). Salient demographics were examined, along with the incidence of post-procedure pneumothorax over 3-days and the 3-month pre-procedural chronic obstructive pulmonary disease (COPD) rates as a potential risk factor for pneumothorax. Procedures were identified by CPT codes, while diagnoses were identified through ICD-9 and -10 codes. The analysis was conducted within the Instant Health Data platform.

RESULTS :

Between 2009-2016, 24,671 patients underwent EBUS while 17,276 patients underwent mediastinoscopy. Procedure cohorts were similar demographically. EBUS grew 62.6% compounded year-over-year while mediastinoscopy declined -18.2%. The rates of post-procedural pneumothorax and COPD diagnosis were statistically significantly different for EBUS (1.9% and 8.2%) and mediastinoscopy (25.2% and 38.2%), (p<0.01 for both). Post-procedural pneumothorax rates were generally consistent across years, though 2015 rates were significantly higher for mediastinoscopy compared to the entire 2009-2016 period.

CONCLUSIONS :

These real-world data complement existing studies and show a growth in EBUS and contemporaneous reduction in mediastinoscopy among patients undergoing thoracic lymph node sampling for lung cancer. Published clinical data shows EBUS is an equally effective yet less invasive procedure, which may explain these trends. Post-procedural pneumothorax rates were consistently greater among patients receiving mediastinoscopy, though differences in pre-procedural COPD status may influence this finding.