Safety Of Transbronchial Needle Aspiration Research Articles

ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION OF A BRONCHOGENIC CYST

SESSION TITLE: Case Report Semifinalists 12 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Bronchogenic cysts are rare congenital malformations that can occur in various parts of the tracheobronchial tree and if symptomatic, can lead to a range of symptoms depending on location [1-2]. Historically, diagnostic confirmation and treatment was achieved via surgical means [1-2]; however, a growing body of evidence exists for the safety and efficacy of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of bronchogenic cysts [3]. CASE PRESENTATION: A 63-year-old female with a known asymptomatic non-FDG avid mediastinal lesion since 2008 presented for a chronic cough. She had previously presented with a right lower lobe pneumonia in early 2017.Physical exam was notable for an oxygen saturation of 97%, comfortably breathing ambient air with clear lung sounds bilaterally. Computed tomography (CT) imaging in late 2017 revealed significant interval increase in the mediastinal lesion which grew from 1.6x2.3cm to 3.0x2.5cm with associated luminal narrowing of the right bronchus intermedius. The mass was noted to be smoothly marginated, 30-40 Hounsfield units in density, and without associated lymphadenopathy or contrast enhancement, most consistent with an enteric duplication or other mediastinal cyst. Additionally, right lower lobe bronchiectasis and associated bronchial mucous plugging with air trapping was noted. The patient underwent flexible EBUS bronchoscopy. The bronchus intermedius was extrinsically obstructed by 75%. EBUS revealed a well demarcated hypoechoic fluid collection most consisted with a cyst. Transbronchial needle aspiration was performed removing 35mL of fluid. Complete resolution of bronchial luminal narrowing was achieved post-aspiration. The patient recovered without complications. Cystic fluid was sent for analysis. Microbiologic stains and cultures were negative. Cytology was notable for rare bland degenerative epithelial cells in a background of mucoid debris. No malignant cells were identified. DISCUSSION: Bronchogenic cysts are rare and may be associated with symptoms ranging from chronic cough to bronchial obstruction with recurrent infections [1-2]. CT imaging has known limitations in establishing the benign cystic characteristics of bronchogenic cysts [1]. They may be diagnosed and treated via surgical resection, which is invasive and has been associated with increased postoperative complications in symptomatic patients [1]. CONCLUSIONS: EBUS-TBNA is a safe and effective alternative to diagnosis and treatment of bronchogenic cysts. Reference #1: Patel SR, Meeker DP, Biscotti CV, et al. Presentation and management of bronchogenic cysts in the adult. Chest 1994;106(1):79-85. Reference #2: Liu HS, Li SQ, Cao ZL, et al. Clinical features and treatment of bronchogenic cyst in adults. Chin Med Sci J 2009;24(1):60-3. Reference #3: Maturu VN, Dhooria S, Agarwal R. Efficacy and Safety of transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports. J Bronchology Interv Pulmonol 2015;22(3):195-203 DISCLOSURES: Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Please note: $5001 - $20000 Added 03/17/2019 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Adrian Mayo, source=Web Response No relevant relationships by Scott Oh, source=Web Response

Efficacy and safety of endobronchial ultrasound-guided transbronchial needle aspiration through the pulmonary arteries for the diagnosis of left hilar lesions.

Endobronchial ultrasonography (EBUS) is an endoscopic method that aids needle aspiration to see the bronchial wall and adjacent tissues with an ultrasound probe. Pulmonary arteries are rarely present between the bronchus wall and the tissue. In this case, it was necessary to make a selection between invasive processes and transbronchial needle aspiration (TBNA) through the pulmonary artery. There are few case reports about the safety of TBNA through the pulmonary artery. We aimed to present the results of EBUS guided TBNA through the pulmonary arteries. The data on four cases (three men) in whom EBUS guided TBNA was performed through the pulmonary artery between August 2010 and December 2015 were reviewed retrospectively. Procedures were conducted under local anesthesia and conscious sedation. For TBNA, 22-gauge needles were used. Cases were monitored for 24 hour after the procedures. Antibiotic prophylaxis and onsite cytopathology were not used. All lesions existed were on the left hilar localization. Two of the diagnosed cases were carcinoma and one was the granulomatous lymphadenitis. We were not able to diagnose the last case. No complication was observed in any cases during the procedure. EBUS guided TBNA through the pulmonary arteries at left hilar lesions is safe. The rate of diagnoses from the tissues obtained is high. No special preparation is needed for the cases have no the pulmonary hypertension.

Efficacy and Safety of Transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports.

Although surgical resection of mediastinal bronchogenic cysts is considered the treatment of choice, there is increasing interest in minimally invasive approaches of management. The purpose of this study was to review the literature on the role of transbronchial needle aspiration (TBNA), either conventional or endobronchial ultrasound (EBUS)-guided, in the diagnosis and management of bronchogenic cysts. We systematically searched the PubMed and EmBase databases for studies (until July 2014) reporting TBNA of bronchogenic cysts. Data were recorded on a standard data extraction form and is presented in a descriptive manner. Our search yielded 26 studies (32 patients). The median age of the patients was 43 years. Most were men (n=15), symptomatic at presentation (n=19), and had cysts in the paratracheal location (n=14). Endosonography was performed on 16 patients. The EBUS appearance of the lesion was hypoechoic and anechoic in 11 and 5 patients, respectively. Thirty-one patients underwent TBNA (conventional: 16; EBUS-guided: 15). The intent of TBNA was therapeutic in 19 patients and diagnostic or symptomatic palliation in the others. Complications were reported in 5 (16.1%) patients [infective (n=4), bradycardia (n=1)] after TBNA; there were no deaths. The median duration of follow-up was 14 months and no recurrences were detected during the follow-up period. Bronchoscopy is a useful tool in the diagnosis of bronchogenic cysts, both for confirmation of the cystic nature of the lesion by EBUS and diagnosis by TBNA (preferably EBUS-guided) of the cyst fluid. Therapeutic aspiration of the cyst may be an alternative to surgery in adults with mediastinal bronchogenic cysts.

Efficacy and Safety of Conventional Transbronchial Needle Aspiration in Sarcoidosis: A Systematic Review and Meta-analysis

Flexible bronchoscopic procedures are currently the most often employed technique for demonstrating granulomatous inflammation in sarcoidosis. Conventional transbronchial needle aspiration (TBNA) has been used for over 3 decades; however, it remains an underutilized technique, primarily due to the wide variations in the reported success rates and unconfirmed safety concerns. Herein we perform a systematic review and meta-analysis of studies to estimate the diagnostic yield and safety of TBNA in sarcoidosis. We searched the PubMed and EmBase databases for studies (1980 to January 2012) reporting the efficacy of TBNA in sarcoidosis. The quality of studies was assessed using the QualSyst tool. The efficacy of TBNA in individual studies was calculated as proportions and 95% CIs, and the results were pooled using a random effects model. Heterogeneity and publication bias were assessed for the individual outcomes. Our search yielded 21 studies (915 patients). The diagnostic yield of TBNA ranged from 6-90%, with the pooled efficacy being 62% (95% CI 52-71%) by the random effects model. TBNA was not associated with any major complication. The diagnostic yield increased to 83% if transbronchial lung biopsy (TBLB) was additionally performed, albeit with increased complications. There was evidence of heterogeneity and publication bias, which significantly decreased on sensitivity analysis after exclusion of retrospective studies. TBNA is an efficacious and safe procedure in the diagnosis of sarcoidosis. The performance of TBLB adds to the efficacy of TBNA. Hence, a combination of TBNA and TBLB should be routinely employed in diagnosis of sarcoidosis in those with enlarged mediastinal lymph nodes.

Diagnostic value of transbronchial needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration for hilar and mediastinal lymph nodes in lung cancer patients

背景与目的经支气管针吸活检（transbronchial needle aspiration, TBNA）和经支气管超声引导针吸活检（endobronchial ultrasound-guided TBNA, EBUS-TBNA）是用于诊断纵隔淋巴结病变的最新检查方法。本研究旨在评价TBNA和EBUS-TBNA对肺癌伴肺门纵隔淋巴结转移的诊断价值及安全性。方法对CT检查疑似肺癌但管腔内无明显新生物且肺门纵隔淋巴结肿大的250例患者行TBNA后行活检或刷检，15例疑似肺癌患者行EBUS-TBNA。结果180例患者TBNA、刷检和活检确诊为肺癌，阳性率分别为82.86%、51.24%和45.45%。15例EBUS-TBNA的阳性率为91.67%。结论TBNA和EBUS-TBNA检查安全性好，准确率高，对肺癌伴肺门纵隔淋巴结转移的患者有较高的诊断价值。

Evaluation of the value and safety of transbronchial needle aspiration in the diagnosis of lung cancer

Objective To evaluate the value and safety of transbronchial needle aspiration (TBNA) in the diagnosis of lung cancer. Methods The cytologic diagnosis of TBNA in 82 patients with enlarged hilar and/or mediastinal lymphnodes or lesions adjacent to the bronchial wall were analyzed retrospectively. All specimens were detected by the ThinPrep cytologic test. Results There were 43 positive cases in the 82 patients, and the positive rate was 52.4 %. There were 18 SCLCs,11squamous cancers, 9 adenocarcinomas and 5 undefinable cancers, respectively. There were 39 patients with local bronchial wall swelling accompanied with abnormal mucosae. TBNA, douche, brushing and forcep biopsy were applied, and the diagnostic rate was 64.1%, 7.7 %, 25.6 % and 48.7 %, respectively. The total positive rate was 76.9 %. 43 patients with normal mucous membrane only underwent TBNA. 18 cases were positive, and the positive rate was 41.9 %. There was no obvious complication in the 82 patients. Conclusion The technique of TBNA enlarged the inspection scope of bronchoscopy. It has significant meaning to the diagnosis of lung cancer. TBNA was an useful and safe method in clinical application and could be used widely. Key words: Lung neoplasms; Bronchoscopy; Biopsy, needle

Successful Real-Time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of a Hilar Lung Mass Obtained by Traversing the Pulmonary Artery

The utility and safety of transbronchial needle aspiration is well described. Serious complications from transbronchial needle aspiration are exceedingly rare. The addition of endoscopic ultrasonographic techniques in the form of endoscopic ultrasonography and, more recently, endobronchial ultrasonography has added valuable information regarding lymphatic anatomy of the hilum and mediastinum. In addition, the use of real-time ultrasound gives the operator visual feedback of needle placement and proximity to major surrounding structures such as the heart and great vessels. Here, the authors present the case of a 74-year-old man with a left hilar mass who underwent biopsy by means of intentional traverse of the pulmonary artery.

Transbronchial Needle Aspiration

Transbronchial needle aspiration (TBNA) has proved its efficacy, safety, and cost-effectiveness in diagnosing and staging bronchogenic carcinoma as well as in diagnosing benign diseases such as sarcoidosis and tuberculosis. However, it is not used as frequently as expected in routine bronchoscopy practice. In an effort to show its use in the Asian-Pacific countries, published TBNA-related articles from these countries have been searched and reviewed. Most of the articles are from Japan, China, Turkey, and India. However, as is seen from the limited number of articles, even in these countries, TBNA is not used extensively. Factors leading to underuse of TBNA include lack of training, suboptimal technique, faulty site selection, incomplete penetration of needle, kinking of the transbronchial catheter, a confusing array of needles, failure to reproduce high diagnostic yields, concerns about the safety of TBNA, inadequate cytopathology support, fear of bronchoscopic damage, and reservations regarding usefulness of this method. There remains no doubt that training with the TBNA technique and experience will improve TBNA results. Collaboration between thoracic surgeons, pulmonologists, oncologists, and pathologists will also help to establish a sound TBNA program in institutions. Only in this way can TBNA be optimized as a nonsurgical, cost-effective, and safe procedure.

Role of Transbronchial Needle Aspiration in Patients Receiving Mechanical Ventilation

s: To evaluate the diagnostic accuracy and safety of transbronchial needle aspiration (TBNA) in patients receiving mechanical ventilation in the ICU. Retrospective review of all patients in the medical and surgical ICUs from February 1999 to July 2001 who underwent TBNA while receiving mechanical ventilation. A total of eight histology (19 gauge) and eight cytology (22 gauge) TBNAs were performed on eight patients (four men and four women). TBNA yielded a definitive pathologic diagnosis in five of eight patients (62.5%). Diagnoses were posttransplantation lymphoproliferative disorder, large cell carcinoma, poorly differentiated non-small cell carcinoma, squamous cell carcinoma, and adenocarcinoma. Among patients with negative TBNA results (n = 3), two patients underwent mediastinoscopy. Results of mediastinoscopy were non-small cell carcinoma and inflamed tissue. TBNA led to management changes in five of these patients. Excluding one patient in whom a negative TBNA result could not be further confirmed, TBNA yielded a sensitivity of 83%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The overall accuracy of the procedure was 75%. There were no complications following any of the TBNAs. In this small group of patients, TBNA was safe and had a high diagnostic accuracy in selected patients receiving mechanical ventilation in the ICU.