Real-time Endobronchial Ultrasound-guided Transbronchial Needle Research Articles

Endobronchial ultrasound-guided biopsy for evaluation of suspected lung cancer.

Purpose Historically, mediastinoscopy has been the gold standard for lung cancer diagnosis and staging, but mediastinoscopy has many limitations including sensitivity, the limited number of lymph node levels that can be sampled, and safety. Endobronchial ultrasound-guided transbronchial needle aspiration is a relatively new and less-invasive technique being used for lung cancer screening. Many studies have reported that it has similar sensitivity and specificity compared to mediastinoscopy, with a significantly lower complication rate. We performed this review to determine our institution’s experience with endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Methods We reviewed the last 150 patients with suspected lung cancer who underwent endobronchial ultrasound-guided transbronchial needle aspiration procedures in our institution from May 26, 2016 to August 31, 2017. Results Ninety-seven of the 150 patients had a confirmed diagnosis of malignancy. Forty patients had a diagnosis other than cancer, and 13 had incomplete information or were lost to follow-up. Endobronchial ultrasound-guided transbronchial needle aspiration was correct in diagnosing malignancy or excluding malignant lymph nodes in 92 of the 97 patients with malignancy. Overall, the sensitivity, specificity, positive-predictive value, and negative-predictive value was 94.0%, 100.0%, 100.0%, and 91.5%, respectively. Only 3 complications were reported: 2 patients suffered minor bleeding, and one suffered major bleeding that resulted in cardiac arrest. Conclusions Real-time endobronchial ultrasound-guided transbronchial needle aspiration has a similar sensitivity and specificity to mediastinoscopy in diagnosing malignancy, with fewer complications and more financial benefit.

Endobronchial ultrasound-guided transbronchial needle aspiration: Safe as it sounds.

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has earned its place as a standard of care in the evaluation of mediastinal and hilar lymphadenopathy. It is a minimally invasive and a safe procedure with high diagnostic accuracy and efficacy. The increased usage of EBUS-TBNA worldwide has thrown light on its possible complications including death. The complications range from minor to life threatening in few and may occur either early or later in the course after the procedure. The present review summarizes the reported complications from EBUS-TBNA, their outcome and the modalities used for their management.

Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10 years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions.This article is a comprehensive, exhaustive review of all the available scientific evidence on the general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined.The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.

Endobronchial ultrasound elastography: a new method in endobronchial ultrasound-guided transbronchial needle aspiration.

TBNA through the flexible bronchoscope is a 37-year-old technology that utilizes a TBNA needle to puncture the bronchial wall and obtain specimens of peribronchial and mediastinal lesions through the flexible bronchoscope for the diagnosis of benign and malignant diseases in the mediastinum and lung. Since 2002, the Olympus Company developed the first generation ultrasound equipment for use in the airway, initially utilizing an ultrasound probe introduced through the working channel followed by incoroporation of a fixed linear ultrasound array at the distal tip of the bronchoscope. This new bronchoscope equipped with a convex type ultrasound probe on the tip was subsequently introduced into clinical practice. The convex probe (CP)-EBUS allows real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar lymph nodes. EBUS-TBNA is a minimally invasive procedure performed under local anesthesia that has been shown to have a high sensitivity and diagnostic yield for lymph node staging of lung cancer. In 10 years of EBUS development, the Olympus Company developed the second generation EBUS bronchoscope (BF-UC260FW) with the ultrasound image processor (EU-M1), and in 2013 introduced a new ultrasound image processor (EU-M2) into clinical practice. FUJI company has also developed a curvilinear array endobronchial ultrasound bronchoscope (EB-530 US) that makes it easier for the operator to master the operation of the ultrasonic bronchoscope. Also, the new thin convex probe endobronchial ultrasound bronchoscope (TCP-EBUS) is able to visualize one to three bifurcations distal to the current CP-EBUS. The emergence of EBUS-TBNA has also been accompanied by innovation in EBUS instruments. EBUS elastography is, then, a new technique for describing the compliance of structures during EBUS, which may be of use in the determination of metastasis to the mediastinal and hilar lymph nodes. This article describes these new EBUS techniques and reviews the relevant literature.

Diez años de ecobroncoscopia lineal: evidencia sobre su eficacia, seguridad y coste-efectividad

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is one of the major landmarks in the history of bronchoscopy. In the 10years since it was introduced, a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions.This article is a comprehensive, systematic review of all the available scientific evidence on the more general indications for this technique. Results of specific studies on efficacy, safety and cost-effectiveness available to date are examined.The analysis shows that EBUS-TBNA is a safe, cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer. However, more studies are needed to guide decision-making in the case of a negative result. Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high, but much lower when used in the study of tuberculosis, lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy. Nevertheless, due to its good safety record and lack of invasiveness compared to surgical techniques, the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases.

Role of real-time endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer

Role of real-time endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer

Endobronchial Ultrasound–guided Transbronchial Needle Aspiration for Non–Small Cell Lung Cancer Staging

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for invasive mediastinal staging of non-small cell lung cancer (NSCLC). Needle-based techniques are now recommended as a first-line diagnostic modality for mediastinal staging. Accurate performance of systematic staging with EBUS-TBNA requires a detailed knowledge of mediastinal anatomy. This examination begins at the N3 lymph nodes, progressing through the N2 and N1 lymph node stations, unless a higher station lymph node is positive for malignant cells by rapid on-site cytologic examination. Objective methods of identifying EBUS-TBNA targets include sampling any lymph node station with a visible lymph node or with a lymph node greater than 5 mm in short axis. Three passes per station or the use of rapid on-site cytologic examination with identification of diagnostic material (tumor or lymphocytes) up to five passes are well-established techniques. Obtaining sufficient tissue for molecular profiling may require performing more than three passes. The operating characteristics of EBUS-TBNA are similar to mediastinoscopy. However, mediastinoscopy should be considered in the setting of a negative EBUS-TBNA and a high posterior probability of N2 or N3 involvement.

Current status and perspective of EBUS-TBNA

In 2002, a new bronchoscope equipped with a convex type ultrasound probe on the tip was introduced into clinical practice. This convex probe endobronchial ultrasound (CP-EBUS) provides a long axis image of surrounding structures of the major airway. The CP-EBUS combined with a dedicated biopsy needle allows real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar lymph nodes. Samples obtained from EBUS-TBNA can be used for pathological diagnosis including immunohistochemistry. EBUS-TBNA is now being performed worldwide for several indications including mediastinal staging, mediastinal pathology and for benign diseases. For mediastinal staging in lung cancer, the diagnostic yield of EBUS-TBNA is comparable to surgical staging in patients with enlarged lymph nodes. In addition, EBUS-TBNA can be used for molecular analysis of tumor cells obtained during the procedure. DNA mutation testing using EBUS-TBNA samples was first reported in 2007 for a chondrosarcoma case. Also, isolated DNA from EBUS-TBNA samples was applied for epidermal growth factor receptor mutation testing and aberrant methylation analysis in patients with lung cancer. RNA was also isolated from properly stored EBUS-TBNA samples and used for gene expression research and aberrant fusion gene detection in lung cancer patients. Optimization of tissue banking methods of EBUS-TBNA specimens was also investigated. Currently, EBUS-TBNA samples can be used for comprehensive mRNA and miRNA expression analysis. EBUS-TBNA will become an important modality for bronchoscopists in the era of personalized medicine in lung cancer.

Efficacy and safety of convex probe EBUS-TBNA in sarcoidosis: A systematic review and meta-analysis

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for diagnosis of mediastinal lymphadenopathy. Although most studies have reported the utility of EBUS-TBNA in malignancy, its use has been extended to benign conditions including sarcoidosis. Herein, we perform a systematic review and meta-analysis of studies reporting the diagnostic yield and safety of EBUS-TBNA in sarcoidosis. We searched the PubMed and EmBase databases for relevant studies published from 2004 to 2011, and included studies that have reported the diagnostic yield of EBUS-TBNA in sarcoidosis. The quality of studies was assessed using the QualSyst tool. We calculated the proportions with 95% confidence interval (CI) to assess the diagnostic yield of EBUS-TBNA in individual studies and then pooled the results using a random effects model. Heterogeneity was assessed using the I(2) and Cochran-Q tests while publication bias was assessed using both graphical and statistical methods. Our search yielded 15 studies (553 patients of sarcoidosis). The diagnostic yield ofEBUS-TBNA ranged from 54 to 93% with the pooled diagnostic accuracy being 79% (95% CI, 71-86%) by the random effects model. The yield was not statistically different in studies employing on-site cytological evaluation (80.1%) vs. those without (81.3%). However, the diagnostic yield was significantly higher in prospective studies (83.9%) vs. the retrospective studies (74.3%). Only five minor complications were reported in 553 patients. There was evidence of heterogeneity and publication bias. EBUS-TBNA is a safe and efficacious procedure in the diagnosis of sarcoidosis, and should be routinely employed wherever available.

Akciğer Kanserinin Teşhisinde ve Mediastinal Evrelemesinde Eş Zamanlı Endobronşiyal Ultrason Kılavuzlu Transbronşiyal İğne Aspirasyonunun Rolü

Akciğer Kanserinin Teşhisinde ve Mediastinal Evrelemesinde Eş Zamanlı Endobronşiyal Ultrason Kılavuzlu Transbronşiyal İğne Aspirasyonunun Rolü

Value of real-time endobronchial ultrasound-guided transbronchial needle aspiration

AIM:The diagnostic value of real-time convex-probe endobronchial ultrasound (CP-EBUS)-guided transbronchial needle aspiration (TBNA) in mediastinal pathologies, and the factors influencing it are not clearly known. This study has been designed to examine factors affecting the efficacy and diagnostic value of CP-EBUS-TBNA.METHODS:Patients (n = 321) with mediastinal mass or enlarged lymph node in the mediastinum, participated in this study, conducted between April 2007 and May 2009. Samples were obtained from the lesions using the TBNA method, with the guidance of CP-EBUS. Histopathologic (in all samples) and microbiologic (in 151 patients’ samples) evaluations were carried out. Biopsy using an appropriate surgical method was taken when the result of the TBNA procedure was nondiagnostic. Thirty-four patients were excluded from the analysis due to several reasons. The diagnostic efficacy of the procedure was analyzed in the remaining 287 patients.RESULTS:The diagnostic rate was 92% (89.7% for the benign diseases and 92.6% for the malignant diseases (P = 0.59)). In granulomatous diseases, the rate was 96% for sarcoidosis and 79% for tuberculosis (P = 0.002). Patients in whom only one lymph node was sampled and in whom two or more lymph nodes were sampled had a diagnostic rate of 85% and 95%, respectively (P = 0.03). When left hilar nodes were sampled, a higher diagnostic rate was achieved (P = 0.01).CONCLUSIONS:CP-EBUS-guided TBNA has a high diagnostic rate. Sampling of at least two separate lymph nodes and the discovery of left hilar station in these lymph nodes increase the rate of diagnosis.

Application of real-time endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging.

Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently introduced technique which allows needle aspiration under real-time ultrasound visualization of the node. Although it has been demonstrated as a useful tool in mediastinal staging of lung cancer, it is not used in most institutes worldwide. Our aim with this report is to share our experience using EBUS-TBNA and to make a short review of the literature. We performed a short review on the existing literature on this technique, paying special attention to our experience in this field. EBUS-TBNA has shown to be useful and safe in detecting metastatic mediastinal and/or hilar lymph nodes in patients with lung cancer. It is also useful as a diagnostic tool in other pathological conditions.

Usefulness of a Lung Cancer Rapid Diagnosis Specialist Clinic. Contribution of Ultrasound Bronchoscopy

Objective To analyse the results obtained in the diagnosis and staging of lung cancer (LC) by a Lung Cancer Rapid Diagnosis Unit (LC-RDU) in which real-time endobronchial ultrasound-guided transbronchial needle aspiration (RT-EBUS guided-TBNA) is performed as part of the clinical evaluation of the patient prior to treatment. Method A four year observational study was conducted on a group of patients evaluated due to suspicion of LC in an LC-RDU. The times and the techniques required for the diagnosis, the treatment period and the level of the disease in the initial staging were recorded. Results Out of a total of 678 patients seen in the LC-RDU, the diagnosis in 352 was confirmed in one or more histopathology tests. In 170 patients (48.2%) the diagnosis was made with biopsies and/ or cytology samples obtained by fibrobronchoscopy, and RT-EBUS guided-TBNA confirmed the clinical suspicion in 70 patients (19.9%). In the 280 patients with NSCLC, 166 RT-EBUS guided-TBNA were performed for staging (59.3%), and in 105 of them the technique only showed local disease (37.5%). Eighty-three of these patients underwent therapeutic surgery, which was radical in 73 cases (87.9%). Conclusion In half of the patients referred to the LC-RDU due to suspected LC, the diagnosis was confirmed in 75% of cases using endoscopic techniques. RT-EBUS guided-TBNA, which was the diagnostic technique in 20% of the cases and for staging in more than half of them, led to reduced waiting times to diagnosis and onset to treatment.

Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Staging of Non-Small Cell Lung Cancer: How Many Aspirations Per Target Lymph Node Station?

Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Staging of Non-Small Cell Lung Cancer: How Many Aspirations Per Target Lymph Node Station?

Real-time endobronchial ultrasound-guided transbronchial needle aspiration: preliminary study on mediastinal and hilar lymph nodes of lung cancer

To observe the value and safety of real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) on mediastinal and hilar lymph nodes of lung cancer. During July 2008 to December 2008, 25 patients (18 males, 7 females), (68 +/- 9) years old, with proven or radiologically suspected lung cancer were enrolled. EBUS-TBNA was performed to obtain samples from 28 lymph nodes of these patients. And 28 lymph nodes of 26 same eligible patients [(18 males, 8 females, (66 +/- 8) years old] were sampled with conventional TBNA by the same operator during January 2008 to June 2008. A positive result was either a specific diagnosis (eg, malignant cells) or a lymphocyte-positive specimen. The results and complications of EBUS-TBNA versus conventional TBNA were compared. The yield of EBUS-TBNA, 92.9%, was significantly higher than 60.7% (17/28 nodes) of conventional TBNA (chi2 = 8.114, P = 0.004). No pneumothorax, airway rupture, hemorrhage (> 5 ml) and other complications were observed for the patients operated with EBUS-TBNA and conventional TBNA. Real-time EBUS guidance significantly increases the yield of TBNA on mediastinal and hilar lymph nodes of lung cancer, and EBUS-TBNA is safe. Further application studies are needed.

Metastatic Mediastinal Lymph Node from an Unidentified Primary Papillary Thyroid Carcinoma Diagnosed by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with a dedicated EBUS bronchoscope has been reported as a minimally invasive and accurate method for sampling specimens from mediastinal and hilar lesions. Using this method, not only cytologic but also histologic specimens, which provide valuable information for a definitive diagnosis, can often be obtained. We report a case of an enlarged metastatic mediastinal lymph node from an unidentified primary papillary thyroid carcinoma that was accurately diagnosed by histological and immunohistochemical examination of tissue obtained by EBUS-TBNA.

Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Staging of Non-Small Cell Lung Cancer: How Many Aspirations Per Target Lymph Node Station?

The goal of this study was to determine the optimal number of aspirations per lymph node (LN) station during endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) for maximum diagnostic yield in mediastinal staging of non-small cell lung cancer (NSCLC) in the absence of rapid on-site cytopathologic examination. EBUS-TBNA was performed in potentially operable NSCLC patients with mediastinal LNs accessible by EBUS-TBNA (5 to 20 mm). Every target LN station was punctured four times. We performed EBUS-TBNA in 163 mediastinal LN stations in 102 NSCLC patients. EBUS-TBNA confirmed malignancy in 41 LN stations in 30 patients. Two malignant LN stations were missed in two patients. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of EBUS-TBNA in predicting mediastinal metastasis were 93.8%, 100%, 100%, 96.9%, and 97.9%, respectively. Sample adequacy was 90.1% for one aspiration, and it reached 100% for three aspirations. The sensitivity for differentiating malignant from benign LN stations was 69.8%, 83.7%, 95.3%, and 95.3% for one, two, three, and four aspirations, respectively. The NPV was 86.5%, 92.2%, 97.6%, and 97.6% for one, two, three, and four aspirations, respectively. Maximum diagnostic values were achieved in three aspirations. When at least one tissue core was obtained by the first or second aspiration, the sensitivity and NPV of the first two aspirations were 91.9% and 96.0%, respectively. Optimal results can be obtained in three aspirations per LN station in EBUS-TBNA for mediastinal staging of potentially operable NSCLC. When at least one tissue core specimen is obtained by the first or second aspiration, two aspirations per LN station can be acceptable.

C4-05: Comparison of Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT in mediastinal staging of NSCLC: focus on histologic types. (preliminary report)

Comparison of Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT in mediastinal staging of NSCLC: focus on histologic types. (preliminary report) Hwangbo, Bin; Lee, Hee Seok; Lee, Ho Young Kim, Hyae Young; Lee, Geon Kook; Nam, Byung Ho; Zo, Jae Ill; Lee, Jin Soo National Cancer Center, Goyang, Korea Background: EBUS-TBNA was reported to have higher diagnostic accuracy in lymph node (LN) staging of lung cancer compared to CT and PET. We conducted a prospective study to compare EBUS-TBNA with PET/CT in mediastinal LN staging, especially focused on histologic types of NSCLC. Methods: EBUS-TBNA was performed in 73 potentially operable NSCLC patients (pts) (M/F 60/13, median age 64 yrs). Chest CT and PET/CT were done before EBUS-TBNA. In case mediastinal LN metastasis was not proved by EBUS-TBNA, surgery was performed. Results: Out of 73 pts, 34 had adenocarcinoma (ADC) and 32 had squamous cell ca (SCC)(large cell ca n=4, non-small cell ca unspecified, n=3). One hundred twenty-six mediastinal LNs (2R = 6, 2L=1, 4R=44, 4L=26, 7N=49) were sampled by EBUS-TBNA in 73 pts. EBUS-TBNA demonstrated metastasis in 34 LN stations in 23pts and missed 1 N2(+) patient (station 7, SCC). Overall, EBUS-TBNA showed higher diagnostic accuracy than PET/CT in mediastinal LN staging (Table, p=0.0075). EBUS-TBNA demonstrated LN metastasis in 3 PET (-) patients. All 3 pts had ADC. In ADC, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT were 81.3% and 83.3% respectively. In SCC, PPV of PET/CT was very low (33.3%) and NPV was high (94.1%). Conclusion: EBUS-TBNA is useful in mediastinal LN staging especially for the pts with mediastinal PET (-) adenocarcinoma and PET (+) NSCLC.

Endobronchial ultrasound-guided transbronchial needle aspiration for the treatment of central airway stenosis caused by a mediastinal cyst

Central airway stenosis caused by compression due to mediastinal cyst is rare. Direct real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method for tissue sampling of the mediastinum. Using this new therapeutic modality, the mediastinum can be punctured repeatedly and safely under local anesthesia with real-time guidance. Cystic lesions are easily detectable, and the Doppler mode helps to distinguish the cystic lesion from vascular structures. We herein report a rare case of central airway stenosis caused by mediastinal cyst successfully treated by EBUS-TBNA with no regrowth after 1 year. A total of 80 ml of fluid content was aspirated, resulting in patency of the trachea.

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

A diagnosis of sarcoidosis should be substantiated by pathological means in order to thoroughly exclude other diseases. The role of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis has not been reported. The purpose of the present study is to evaluate the diagnostic yield of EBUS-TBNA in demonstrating the pathological features of sarcoidosis. In total, 65 patients with suspected sarcoidosis, with enlarged hilar or mediastinal lymph nodes on computed tomography, were included in the study. Patients with a suspected or known malignancy or previously established diagnosis of sarcoidosis were excluded. Convex probe endobronchial ultrasonography integrated with a separate working channel was used for EBUS-TBNA. Surgical methods were performed in those in whom no granulomas were detected by EBUS-TBNA. Patients were followed up clinically. EBUS-TBNA was performed on a total of 77 lymph node stations in 65 patients. A final diagnosis of sarcoidosis was made for 61 (93.8%) of the patients. The remaining four patients were diagnosed as having Wegener's granulomatosis (n=1) or indefinite (n=3). In patients with a final diagnosis of sarcoidosis, EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 56 (91.8%) of the patients. No complications were reported. Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnoses of sarcoidosis.