Endobronchial Ultrasound-guided Transbronchial Needle Aspiration In Diagnosis Research Articles

Endobronchial ultrasound- guided transbronchial needle aspiration for mediastinal lymph node staging in patients with typical pulmonary carcinoids

BackgroundPulmonary carcinoids, which are well-differentiated lung neuroendocrine carcinomas, account for only 1–2 % of primary lung malignancies. Although fluorodeoxyglucose positron-emission tomography/computed tomography performs poorly in the identification of mediastinal lymph node metastases, particularly for pulmonary carcinoids, endobronchial ultrasound-guided (EBUS) transbronchial needle aspiration (TBNA) may be a useful means of preoperative nodal assessment in patients with these conditions. However, the diagnostic performance of EBUS TBNA is unknown. This study was designed to determine the sensitivity of EBUS for mediastinal staging in patients with typical carcinoid. Study design and methodsA retrospective review of all patients with carcinoids who underwent EBUS TBNA and/or surgical resection with lymphadenectomy at The University of Texas MD Anderson Cancer Center was performed. The sensitivity of EBUS –TBNA in diagnosis of mediastinal lymph node metastases was determined. ResultsOf the 212 patients with pulmonary carcinoids we identified, 137 had surgery with no preoperative EBUS TBNA, 68 had EBUS TBNA followed by surgery, and 7 had EBUS TBNA only. The sensitivity rate for EBUS TBNA in diagnosis of mediastinal lymph node metastases was 77.78 % overall (95 % CI, 57.7−91.3%) and it was 87.5 % (95 % CI, 67.6−97.3%) when we considered only patients with EBUS TBNA-accessible lymph nodes. DiscussionThe sensitivity of EBUS TBNA for diagnosis of mediastinal lymph node metastases of pulmonary carcinoids was slightly lower than that reported previously for non-small cell lung cancer. Preoperative EBUS TBNA identified nodal metastases not previously identified by imaging.

Utility of microbiological testing of thoracic lymph nodes sampled by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal lymphadenopathy

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents a minimally invasive technique to sample peribronchial and mediastinal lymph nodes for diagnosis of cancer, lymphoma, or sarcoidosis. However, the value of EBUS-TBNA in diagnosis of respiratory infections has not been well explored. Here, microbiologic testing data for EBUS-TBNA samples collected from 82 patients over a 30-month period were retrospectively reviewed. No organisms were identified on Gram, acid-fast, or fungal stains. Bacterial cultures were positive in 52% of samples; however, all but 1 culture were considered contaminants. Mycobacterial cultures yielded Mycobacterium avium-intracellulare not identified in a concurrent bronchoalveolar lavage sample in 1 patient. Fungal cultures were negative. Overall, routine microbiologic tests on EBUS-TBNA samples do not appear sufficiently sensitive to rule out infectious causes of adenopathy. High clinical suspicion for infection may require modification of sampling techniques or more sensitive detection methods.

Evaluation of the value of EBUS-TBNA in diagnosis of mediastinal lesions

To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosis of mediastinal lesions and to discuss its optimal indication. One hundred and twenty three patients with mediastinal lesions who underwent EBUS-TBNA were included in this study. The accuracy, sensitivity, specificity, positive and negative predictive value of EBUS-TBNA in diagnosis of mediastinal lesions were analyzed according to the final diagnosis and evaluate its value and the optimal indication. In the 123 patients, EBUS-TBNA was successfully performed to obtain samples from 286 stations of lymph nodes (2.33 stations/per patient). The puncture success rate was 100%. The procedure was uneventful without complications. Final diagnosis indicated that there were 83 positive and 40 negative patients. EBUS-TBNA had a sensitivity of 95.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.0%, and overall accuracy of 96.8%. For diagnosis of the epithelial cancer, EBUS-TBNA had an accuracy of 98.8%, sensitivity of 98.8%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. EBUS-TBNA failed to reveal three lymphomas. For diagnosis of benign mediastinal diseases, EBUS-TBNA had a diagnosis rate of 47.2% which had a confirmed clinical application value. EBUS-TBNA may be expected to replace the mediastinoscopy as a superior choice for diagnosis of mediastinal epithelial cancers. EBUS-TBNA can not replace mediastinoscopy but being a promising tool for diagnosis of benign mediastinal lesions including granulomas. For certain special diseases such as lymphoma, mediastinoscopy cannot be replaced. However, EBUS-TBNA can be a potentially favorite choice for early stage screening.

Initial experience with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from a tuberculosis endemic population.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely accepted minimally invasive procedure for the evaluation of mediastinal lymphadenopathy. Most of the published literature on EBUS-TBNA is focused on the diagnostic and staging aspects of lung cancer. Literature on the utility of this modality from developing countries and settings with a high prevalence of tuberculosis (TB) is limited. We herein describe our preliminary experience over 1 year on the utility of EBUS-TBNA from a tertiary care teaching center in North India. The primary objective was to evaluate the utility of convex probe EBUS-TBNA as a modality for diagnosis in patients with mediastinal lymphadenopathy presenting to our center. EBUS-TBNA was performed under local anesthesia and conscious sedation in the bronchoscopy laboratory. Rapid on-site evaluation was available for most of the procedures. Patients were discharged the same day from the hospital. A total of 102 patients with mean age of 42.1±14.2 years underwent EBUS-TBNA for a clinical indication of enlarged mediastinal lymph nodes, between September 2012 and September 2013.There were 63 males (61.8%) and 39 females (38.2%). EBUS-TBNA was performed for staging lung cancer in 5 patients.A total of 216 lymph node stations were sampled in 102 patients. Rapid on-site evaluation was performed in 95 patients (93.1%). Adequate/representative samples could be obtained in 98 of 102 patients (96.1%). Overall, EBUS-TBNA was diagnostic in 76 patients (74.5%). EBUS-TBNA was diagnostic in 80.9%, 84.8%, and 75% of patients with sarcoidosis, TB, and lung cancer, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 81.7%, 100%, 100%, and 22.73%, respectively. EBUS-TBNA is a safe and efficacious procedure for obtaining tissue diagnosis in patients with mediastinal lymph node enlargement. The yield of EBUS-TBNA in diagnosis of mediastinal lymph node enlargement due to TB is especially high.

Endobronchial ultrasound for diagnosis of synchronous primary lung cancers

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be accurate in diagnosis and staging of mediastinal lymph node metastases. We report a case of squamous cell carcinoma diagnosed by endobronchial biopsy with concomitant contralateral hilar lymph node metastasis from small cell carcinoma being confirmed by EBUS-TBNA. The diagnosis of synchronous primary lung cancers in this case, which altered the treatment strategy, would not be made if pathological staging of intrathoracic lymph node was not pursued. The unique role of EBUS-TBNA in diagnosis of hilar lymphadenopathy was underscored. The potential pitfall of missing synchronous lung tumour if the diagnosis is based either on sampling from intrathoracic lymph node or from endobronchial lesion alone is discussed.