"To do or not to do - that is the question". Transvascular needle aspiration during EBUS (EBUS-TVNA) with review of the literature.

Arvind Perathur,Tinku Joseph,Umesh Varma,Sreeraj Nair

doi:10.5603/arm.a2021.0074

Arvind Perathur, Tinku Joseph + Show 2 more

Open Access

https://doi.org/10.5603/arm.a2021.0074

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Abstract

Large vessels are often encountered during endobronchial ultrasound (EBUS). Safety of traversing the vessels weighed against a more invasive procedure can be a dilemma. We describe a case series of 8 patients who underwent transvascular needle aspiration during EBUS, to access a lesion in the absence of an alternate safe window. A 21 gauge EBUS needle was used to traverse either the main or a major branch of the pulmonary artery. Malignancy was suspected at ROSE in five cases. Granuloma and necrosis noted in 2 cases were confirmed as tubercu-losis on culture. Diagnostic yield of EBUS-TVNA was 87.5% (7/8). No complications were noted in the immediate post-operative period as well as during 6 months of follow up. EBUS-TVNA in carefully selected patients is a feasible alternative to more invasive procedures with excellent yield. Appropriate intraoperative, perioperative and postoperative monitoring and care must be available in the case of fatal bleeds.

Highlights

Large vessels are often encountered during endobronchial ultrasound (EBUS)
Invasive sampling of the mediastinal lymph nodes for lung cancer staging is recommended by American Thoracic Society (ATS), European Respiratory Society (ERS), and American College of Chest Physicians (ACCP) [1]
rapid onsite evaluation (ROSE) identified necrosis in 1 and granuloma in another subject, both of which were diagnosed as tuberculosis

Summary

Introduction

Large vessels are often encountered during endobronchial ultrasound (EBUS). Safety of traversing the vessels weighed against a more invasive procedure can be a dilemma. Some stations in the mediastinum are inaccessible or, access to these locations is limited by the presence of one of the great vessels These areas include stations 3a, 5 and 6 and elsewhere in the hilum when a branch of the pulmonary artery or more proximally, azygos, superior vena cava or brachiocephalic vessels, may be interposed between the airway and the pathology. These were once upon a time considered beyond the reaches of EBUS [4] because biopsy of these lesions needed traversing the great vessels. Multiple case series have been published confirming relative safety of traversal of the great vessels in experienced hands [7,8,9,10,11]

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