Endobronchial Ultrasoud Guided Transbronchial Needle Aspiration

Ashesh Dhungana,Harish Chandra Upreti,Kiran Shrestha,Prajowl Shrestha,Pratikchya Karki,Shristi Shah

doi:10.3126/jnhrc.v16i3.21437

Abstract

Evaluation of mediastinal lymphadenopathy is often challenging. Endobronchial Ultrasound (EBUS) is a novel technique which provides real time sonographic guidance during Transbronchial Needle Aspiration (TBNA) from mediastinal and hilar lesions. A 60-year-old smoker presented with two months history of cough and chest pain on the right side. CT thorax revealed a right upper lobe spiculated mass with paratracheal (Station 4R) and subcarinal (Station 7) lymph nodes. Bronchoscopy did not reveal any endobronchial mass. Since EBUS-TBNA is superior to conventional TBNA for malignant mediastinal node, an EBUS- TBNA was performed from both lymph node stations. . Cytopathology and histopathology revealed non-small cell lung cancer. We hereby report the first use of EBUS-TBNA in Nepal, in a patient with lung cancer and mediastinallymphadenopathy.

Highlights

Mediastinal lymphadenopathy is common with various malignant and benign conditions
CP-Endobronchial Ultrasound (EBUS) was initially developed for diagnosis and staging of lung cancer, recent years have seen the extension of its use in benign conditions like tuberculosis and sarcoidosis.[2]
As a minimally invasive tool, EBUS is superior to conventional Transbronchial Needle Aspiration (TBNA) for diagnosis and staging of lung cancer.[3,4]

Summary

INTRODUCTION

Mediastinal lymphadenopathy is common with various malignant and benign conditions. The diagnosis is often challenging and requires tissue sampling. A 60-year-old male with 15 pack years of smoking, presented with two months history of dry cough and chest pain on the right side His pulse rate was 78/min and Blood Pressure was 132/76 mmHg. There were no palpable peripheral lymph nodes. Computed Tomography (CT) of the thorax showed small spiculated nodule in the right upper lobe measuring 16X14mm, with mild right pleural effusion and heterogenous right paratracheal node and subcarinal node (Figure 1). EBUS revealed a heterogeneous right paratracheal node measuring 18x14 mm and subcarinal node measuring 16x12mm (Figure 2). EBUS guided transbronchial needle aspiration (EBUS-TBNA) was performed from the subcarinal and right paratracheal node (Figure 3). Histopathology revealed atypical cells in loose clusters with individual cells showing mild to moderate pleomorphy with enlarged, hyperchromatic nuclei and abundant amount of eosinophilic cytoplasm. Patient is scheduled for complete staging workup and planned to start platinum based doublet chemotherapy

DISCUSSION

CONCLUSIONS