Endobronchial and/or Endoesophageal Bronchoscopic Ultrasound-Guided Fine Needle Aspiration in the Diagnosis of Mediastinal and Hilar Diseases of Unknown Etiologies

Mohamed Sayed Hantera,Ibrahim Salah-Eldein Ibrahim,Ali Mohamed Abdellah,Amira Abdelgalil Elkholy,Ayman Mohamed El-Saka,Fawzy Abo-Elnaga El-Emery,Ayman Abdelhamid Farghaly,Dalia Ezzat Elsharawy

doi:10.11648/j.ijmi.20210901.19

Abstract

Introduction: Diagnosis of mediastinal and hilar lesions represents a problematic issue for long ago, not only due to various structures that occupy this space but also difficult accessibility to such lesions. Mediastinal endosonography – guided FNA is emerged as a new minimally invasive modality for diagnosis of such lesions. Objectives: to evaluate the role of endobronchial and/ or endoesophageal -bronchoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal and hilar diseases of unknown etiologies. Methods: This Prospective observational study was carried out at Tanta University Educational Hospital and Kobri Elkobba Military Hospitals; from December 2017 to December 2019 on thirty patients (19 males; 11 females, age range 17-82 years) presented with undiagnosed mediastinal and or hilar lesions. All patients were subjected to clinical examination, radiological assessment including Chest-X-Ray, CT Chest. Laboratory investigations: CBC, blood urea, serum creatinine and coagulation profile. Twenty-six patients were subjected only to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsies and four patients were subjected to endoscopic ultrasound using EBUS scope-guided fine- needle aspiration (EUS-B-FNA) after EBUS-TBNA, using Pentax Endobronchial ultrasound and a fine needle (22- Gauge). The procedure was done under local anesthesia and conscious sedation ROSE technique was applied for some cases. Results: Definitive diagnosis was reached in twenty-nine cases, achieving diagnostic yield (96.67%). Malignant lesions were the predominant category; twenty (66.67%), while nine (30%) were diagnosed as benign lesions and one (3.33%) case remained un diagnosed. Also, immunohistochemistry played an important role to reach definitive diagnosis in six cases without further sampling. About (12/30; 40%) of patients were passed without any complications while the others recorded controlled complications without any serious events. Conclusion: EBUS and EUS-B-FNA are minimally invasive, complementary and cost effective procedures with high diagnostic yield for mediastinal and hilar lesions. Addition of immunohistochemistry raises diagnostic value of this procedure.

Highlights

Diagnosis of mediastinal and hilar lesions represents a problematic issue for long ago, due to various structures that occupy this space and difficult accessibility to such lesions
All patients were subjected to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS – TBNA) and endoscopic ultrasound using EBUS scope-guided fine- needle aspiration (EUS-B-FNA) was reserved for cases in whom endobronchial approach was difficult and not feasible for sampling the lesions, after endobronchial trial using Pentax Convex Probe - Endobronchial ultrasound-1970UK, HI VISION Avius; Hitachi Company, Tokyo, Japan and a dedicated 22-Gauge Needle; ECHO-HD-22-EBUS-P of Cook Medical Company (Limerick, Ireland) for aspiration of lesions
The procedure was done under local anesthesia to nose and mouth, conscious sedation and oxygen supplementation using nasal cannula

Summary

Introduction

Diagnosis of mediastinal and hilar lesions represents a problematic issue for long ago, due to various structures that occupy this space and difficult accessibility to such lesions. Mediastinal endosonography – guided FNA is emerged as a new minimally invasive modality for diagnosis of such lesions. Objectives: to evaluate the role of endobronchial and/or endoesophageal -bronchoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal and hilar diseases of unknown etiologies. Results: Definitive diagnosis was reached in twenty-nine cases, achieving diagnostic yield (96.67%). Immunohistochemistry played an important role to reach definitive diagnosis in six cases without further sampling. Conclusion: EBUS and EUS-B-FNA are minimally invasive, complementary and cost effective procedures with high diagnostic yield for mediastinal and hilar lesions. [2] Endoscopic biopsy under the guidance of ultrasonography is one of sampling techniques which can be done either through air ways (Endobronchial ultrasound; EBUS) or through the oesophagus (Endoscopic ultrasound; EUS). [3] Both EBUS-TBNA and EUS-fine needle aspiration provide a nearly complete mediastinal evaluation in a minimally invasive manner. Mediastinal symptoms result from compression of involved structures; such trachea, esophagus and so on. [1] Divisions of mediastinum help in narrowing differential diagnosis and choosing appropriate sampling modality which is often required to confirm diagnosis and select optimal treatment. [2] Endoscopic biopsy under the guidance of ultrasonography is one of sampling techniques which can be done either through air ways (Endobronchial ultrasound; EBUS) or through the oesophagus (Endoscopic ultrasound; EUS). [3] Both EBUS-TBNA and EUS-fine needle aspiration provide a nearly complete mediastinal evaluation in a minimally invasive manner. [4]

Objectives

Methods

Results

Discussion

Conclusion