Transbronchial Aspiration Research Articles

Supernatant fluid from endobronchial ultrasound-guided transbronchial needle aspiration for rapid next-generation sequencing

There is an increasing demand to optimize the workflow and maximize tissue available for next-generation sequencing (NGS) for non-small cell carcinoma. We looked at transbronchial needle endobronchial ultrasound-guided bronchoscopy with transbronchial needle aspiration samples and evaluated the performance of supernatant (SN) fluid processed from a dedicated aspirate collected for NGS testing. Nineteen samples were collected and processed using a new workflow. Five aspirates were collected in formalin. One additional dedicated pass was collected fresh and centrifuged. The resulting cell pellet was added to formalin for cell block (CB) processing. DNA and RNA were extracted from concentrated SN for targeted testing using the Oncomine Precision Assay (Thermo Scientific, Waltham, MA). NGS results from the corresponding CB samples were used as "controls" for comparison. Thirty-one mutations were detected in SN (Table1). The most frequently mutated genes were TP53 (35%), EGFR (23%), KRAS (13%), CTNNB1 (6%), and ERBB2 (6%). There was 100% concordance between the mutations detected in SN and corresponding CBs with comparable variant allele frequencies. Turnaround time of NGS results was 1 day for SN compared to 4-10 days for CB. We were able to demonstrate the usefulness of SN for reliable rapid molecular results. We successfully incorporated the workflow for tissue handling and processing among our clinical, cytopathology, and molecular teams. Molecular results were available at the same time as the cytologic diagnosis, allowing for timely reporting of a comprehensive diagnosis. This approach is particularly useful in patients with advanced disease requiring urgent management.

32 - Endobronchial ultrasound–transbronchial nodal aspiration (EBUS-TBNA) with rapid on-site evaluation (ROSE) in the Ulster Hospital, 2021

32 - Endobronchial ultrasound–transbronchial nodal aspiration (EBUS-TBNA) with rapid on-site evaluation (ROSE) in the Ulster Hospital, 2021

Latent Mycobacterial fortuitum infection presenting as ocular sarcoidosis

A 62-year-old lady presented with bilateral granulomatous uveitis and cystoid macular edema. A diagnosis of ocular sarcoidosis was made (revised International Workshop on Ocular Sarcoidosis [IWOS] criteria) on the basis of lymphopenia, negative Mantoux, and QuantiFERON TB gold tests. Enlarged mediastinal lymph nodes, subpleural nodules, and nodular interstitial thickening were seen on high-resolution computed tomography (HRCT) thorax. Non-necrotizing granulomato us inflammation, negative for mycobacteria on staining and GeneXpert, was noted on endobronchial ultrasound-guided transbronchial lymph node aspiration (EBUS-TBNA). However, culture grew Mycobacterium fortuitum after 3 weeks. This case highlights a rare presentation of latent M. fortuitum infection presenting as ocular sarcoidosis, speculating the coexistence of two diseases in an individual, one possibly triggering the other.

Efficacy of TBNA needles for EBUS during fiberoptic bronchoscopy?

Conventional transbronchial needle aspiration (cTBNA) biopsy is a diagnostic minimally invasive technique applied using fibreoptic bronchoscopy (FOB) in the evaluation of mediastinal/hilar lymph nodes. With the development of endobronchial ultrasound (EBUS) devices, transbronchial aspiration needles have been revised for use according to the EBUS guidelines. The main aim of this research was to evaluate the diagnostic success of transbronchial aspiration needles that was produced for EBUS when it was applied with FOB instead of conventional TBNA. A retrospective examination was made with the data of 35 patients applied with FOB TBNA, using needles specifically designed for EBUS and 36 patients with conventional TBNA (cTBNA group), for lung cancer staging or the diagnosis of mediastinal lymphadenopathy between November 2018 and November 2019. Seventy-two and sixty procedures performed on 71 patients were included in the study. Diagnostic efficiency for TBNA and cTBNA groups were 91.4% and 83.3%, respectively. Conventional TBNA is still acceptable when the low cost and ease of application are taken into consideration. In conclusion, improvement of current conventional TBNA needles similar to EBUS-TBNA needles for more efficient aspiration capacity could be the first stepto increasing the TBNA diagnostic yield. Nevertheless, further studies are needed to confirm our results.

Multimodal linear endobronchial ultrasound guided mediastinal lymph node biopsy in the diagnosis of isolated mediastinal lymphadenopathy

Isolated mediastinal lymphadenopathy represents a common diagnostic dilemma whereby morphological analysis of tissue specimens are frequently needed to ascertain the diagnosis. Cryobiopsy by linear endobronchial ultrasound (EBUS) guidance had recently been described in literature. We described a multimodality biopsy approach of a case of isolated tuberculous mediastinal lymphadenitis in which we employed the 22-gauge transbronchial aspiration needle, mini-forceps and a flexible cryoprobe sequentially. We aim to highlight the novel technique of linear EBUS guided cryobiopsy in acquiring superior histological specimen from mediastinal lymphadenopathy for diagnosis purposes. We also compared the histopathological quality of the specimens acquired from these three different biopsy modalities.

P6‐18: Endobronchial ultrasound transbronchial aspiration biopsy (EBUS‐TBNA) in the diagnosis of mediastinal mass of unknown etiology: A case series

P6‐18: Endobronchial ultrasound transbronchial aspiration biopsy (EBUS‐TBNA) in the diagnosis of mediastinal mass of unknown etiology: A case series

Eosinophils may serve as CEA-secreting cells for allergic bronchopulmonary aspergillosis (ABPA) patients

Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterized by an exaggerated response of the immune system to the fungus Aspergillus. This study aimed to assess the relationship between carcinoembryonic antigen (CEA) and eosinophils in ABPA patients. We describes a case of a 50-year-old patient who was diagnosed with ABPA presenting with high level of CEA and eosinophils. Besides,we used immunohistochemistry and immunofluorescence to identify eosinophils and CEA in sections which were obtained by Endobronchial ultrasound-guided transbronchial lung biopsy aspiration (EBUS-TBLB). The sections were then visualized using confocal microscopy. We also retrospectively analyzed a cohort of 37 ABPA patients between January 2013 and December 2019 in our hospital. We found the patient whose serum CEA levels were consistent with eosinophils during the follow-up (r = 0.929, P = 0.022). The positive expression of CEA and abnormal expression of eosinophils was higher in the ABPA tissue compared to the normal lung tissue. The co-localization was represented as pixels containing both red and green color in the image (with various shades of orange and yellow) which signified that eosinophils were immunohistochemically positive for CEA. Patients with higher levels of eosinophils had higher levels of CEA in the serum (P < 0.001). The results of Pearson correlation analysis showed that the levels of eosinophils were positively correlated with serum CEA levels (r = 0.459 and r = 0.506, P = 0.004 and P = 0.001). Serum CEA level is elevated in ABPA patients. The elevated serum CEA level was shown to be normalized after treatment. Increased CEA levels in ABPA patients may be positively correlated with eosinophil levels, and eosinophils may be served as CEA-secreting cells in patients with ABPA.

The diagnosis of lung cancer in the era of interventional pulmonology.

Advances in bronchoscopic and other interventional pulmonology technologies have expanded the sampling procedures pulmonologist can use to diagnose lung cancer and accurately stage the mediastinum. Among the modalities available to the interventional pulmonologist are endobronchial ultrasound-guided transbronchial needles aspiration (EBUS-TBNA) and transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for sampling peribronchial/perioesophageal central lesions and for mediastinal lymph node staging, as well as navigational bronchoscopy and radial probe endobronchial ultrasound (RP-EBUS) for the diagnosis of peripheral lung cancer. The role of the interventional pulmonologist in this setting is to apply these procedures based on the correct interpretation of clinical and radiological findings in order to maximise the chances of achieving the diagnosis and obtaining sufficient tissue for molecular biomarker testing to guide targeted therapies for advanced non-small cell lung cancer. The safest and the highest diagnosis-yielding modality should be chosen to avoid a repeat sampling procedure if the first one is non-diagnostic. The choice of site and biopsy modality are influenced by tumour location, patient comorbidities, availability of equipment and local expertise. This review provides a concise state-of-the art account of the interventional pulmonology procedures in the diagnosis and staging of lung cancer.

Influence of technological parameters of performing transbronchial aspiration biopsy of mediastinal lymph nodes under endosonography control on its sensitivity in the diagnosis of mediastinal lymphadenopathy

<h3>ОБОСНОВАНИЕ</h3> Лимфаденопатия средостения — рентгенологический синдром, проявляющийся увеличением лимфатических узлов (ЛУ). Этиологические причины представляют собой гетерогенную группу. Одним из новых методов диагностики является трансбронхиальная аспирационная биопсия ЛУ средостения под контролем эндосонографии (EBUS-TBNA). <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Определение технологических параметров, влияющих на информативность EBUS-TBNA при верификации лимфаденопатии средостения. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В проспективное нерандомизированное исследование с февраля 2012 г. по февраль 2020 г. включены 235 пациентов в возрасте 18 лет и старше с коротким диаметром (1 см или более) как минимум одного из ЛУ групп 4R, 7 и 4L. EBUS-TBNA выполнена при помощи ультразвукового бронхоскопа и ультразвукового сканера. Пункции выполнены специальными ультразвуковыми трансбронхиальными иглами размером 22G. Для математической обработки использовался метод построения деревьев классификаций (метод CHAID). <h3>РЕЗУЛЬТАТЫ</h3> Общая чувствительность метода составила 80%. Чувствительность при пункции 1, 2 и 3 групп и более составила 65, 83 и 85% соответственно, при использовании активной аспирации — 84%. <h3>ЗАКЛЮЧЕНИЕ</h3> Факторами, которые способствуют повышению чувствительности EBUS-TBNA с целью верификации лимфаденопатии средостения, являются биопсия 2 групп ЛУ и более средостения и использование активной аспирации.

Pilot Study of the Performance of 19-G Needle in Endobronchial Ultrasound-guided Transbronchial Aspiration for the Diagnosis and Testing of Molecular Markers in Lung Cancer.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the standard for diagnosis and staging of lung cancer. Historically, 21- and 22-G needles have been paired with EBUS. We evaluated the performance of EBUS-TBNA using a larger 19-G needle in the assessment of tumor tissue obtained and success of testing for molecular markers. We prospectively enrolled adult patients with lymphadenopathy concerning for metastatic lung cancer. Patients underwent diagnostic EBUS-TBNA utilizing 19-G needles. Cases of non-small cell lung cancer (NSCLC) were evaluated for programmed cell death receptor ligand (PD-L1) expression. Cases of adenocarcinoma or undifferentiated NSCLC were further evaluated for 3 molecular markers for driver mutations: epidermal growth factor receptor (EGFR), c-ros oncogene 1 (ROS-1), and anaplastic lymphoma kinase (ALK). Fifty patients were enrolled and underwent EBUS-TBNA using 19-G needles. PD-L1 assay was successfully performed in 90% of NSCLC cases. In adenocarcinoma or undifferentiated NSCLC cases, the success rate in testing was 90% for EGFR and 86% for ALK. ROS-1 testing had a success rate of 67%; 24% of these specimens had adequate tumor cells but there was technical difficulty with the assay. Block quality was judged by total number of tumor cells per hematoxylin and eosin-stained slide of each cell block (58% of specimens had >500 cells and 22% had 200 to 500 cells). There were no adverse events. EBUS-TBNA using 19-G needles can obtain a high number of tumor cells and has a high rate of success in performing assays for PD-L1, EGFR, and ALK in NSCLC patients without an increase in adverse events. The success rate of ROS-1 testing was lower.

A RARE CASE OF PARANEOPLASTIC EDEMATOUS DERMATOMYOSITIS ASSOCIATED WITH SMALL CELL LUNG CANCER

SESSION TITLE: Lung Cancer: Unusual Presentations SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/21/2019 3:15 PM - 4:15 PM INTRODUCTION: Paraneoplastic edematous dermatomyositis (EDM) as a manifestation of Small Cell Lung Cancer (SCLC) is a rare process with one reported case in the literature. CASE PRESENTATION: We present a 51-year-old, previously healthy woman with a nine pack-year smoking history, who presented with a one-month history of progressive facial edema, facial erythema, lip swelling, and a violaceous atypical rash with crusting lesions involving her extremities, anterior neck, chest wall (V sign), and periungual area. The erythematous rash with blistering initially developed on the undersurface of both forearms after exposure to a wheelchair which the patient attributed to a nickel allergy. The patient failed low-dose outpatient steroids and was admitted with progressive lip swelling and facial edema. Over the course of her hospitalization, the patient developed significant proximal muscle weakness, proximal muscle tenderness, and was found to have an elevated creatine kinase level of 5,912 [IU]/L, antinuclear antibody titer was positive at 1:640 dilution, and a dermal biopsy consistent with dermatomyositis. Chest CT revealed a hilar mass with precarinal adenopathy. The patient underwent endobronchial ultrasound with transbronchial aspirate demonstrating SCLC. The patient’s facial edema and atypical rash responded to high-dose oral prednisone although proximal weakness persisted at discharge from the hospital. Upon follow up with hematology and oncology, the patient was formally diagnosed with limited stage SCLC and initiated on etoposide and carboplatin with radiation therapy. Additional evaluation with CT Abdomen demonstrated no evidence of distant metastasis. After completion of her chemoradiotherapy, her subcutaneous edematous rash resolved. DISCUSSION: A review of the literature suggests that EDM is rare with only 23 cases reported to date. EDM may be associated with a higher mortality and a more fulminant course. CONCLUSIONS: Familiarity with this paraneoplastic phenomenon may lead to early diagnosis of treatable malignancies and decrease short term mortality. Reference #1: Zarrabi, K., et al., Paraneoplastic edematous dermatomyositis: A rare syndromeobserved in a case of small cell lung cancer. Clinics and practice, 2017. 7(4). Reference #2: Milisenda JC, Doti PI, Prieto-González S, Grau JM. Dermatomyositis presenting withsevere subcutaneous edema: five additional cases and review of the literature. SeminArthritis Rheum 2014; 44:228. DISCLOSURES: No relevant relationships by James Davidson, source=Web Response No relevant relationships by Jeremy Harvey, source=Web Response No relevant relationships by Rahul Sampath, source=Web Response No relevant relationships by Mathew Thomas, source=Web Response No relevant relationships by Ly Tran, source=Web Response

Abstract 1792: Exploring new therapeutic options for chemoresistant locally advanced lung cancer

Abstract Background: Non-small-cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide. About one third of NSCLC patients present at diagnosis with locally advanced disease (stage IIIA) which are characterized by lymph node metastases. For this group of patients, neoadjuvant chemotherapy (NACT) followed by surgery is the best therapeutic option. However, clinical response to NACT is heterogeneous including patients with a complete eradication of lymph node metastases (pN0), and patients with persistent disease (pN2). Of note, 'pN0' patients showed a favourable prognosis (~50-60% survival, at 5-year) when compared to 'pN2' patients (~20-30% survival, at 5-year). Methods: To identify new molecular determinants involved in NACT response, we recently performed whole-microRNA expression profiling of metastatic lung tumor cells, which were collected from mediastinal lymph nodes before NACT either by endobronchial ultrasound transbronchial aspiration (EBUS-TBNA) (n=11) or mediastinoscopy (n=41). In addition, we performed a meta-analysis of a cohort (n=84) of NSCLC (i.e. The Cancer Genome Atlas LUAD and LUSC dataset) with complete follow-up. Results: We found a set of 20 miRNAs significantly differentially expressed in pN2 vs. pN0 tumors. Hierarchical clustering analysis using this 20-miRNA set revealed a clear separation of pN0 patients from pN2 patients. However, when the 20-miRNA set was used in the primary NSCLCs from TCGA dataset, the chemoresponsive and chemoresistant tumors could not be stratified. This possibly suggests unique properties of this 20-miRNA set and their modulated target genes in metastatic cells, and in the acquisition of a chemoresistant phenotype. Furthermore, by coupling miRNA and mRNA expression profile in metastatic samples, we rewired i) cancer intrinsic gene networks with a role in chemotherapy resistance, and ii) an augmented infiltration of tumor promoting immune cell populations (TILs). Conclusions: Lung cancer metastases are intrinsically distinct and there exist molecular subtypes with different NACT response, identifiable by miRNA expression profile. Future efforts will be directed to identify the landscape of molecular mechanisms mediated by miRNAs, including the modulation of TILs possibly involved in the acquired chemoresistance. Citation Format: Roberto Cuttano, Elisa Dama, Valentina Melocchi, Tommaso Colangelo, Cristiano Carbonelli, Giorgia Maroni, Elena Levantini, Fabrizio Bianchi. Exploring new therapeutic options for chemoresistant locally advanced lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1792.

A Prospective, Randomized Trial for the Comparison of 19-G and 22-G Endobronchial Ultrasound-Guided Transbronchial Aspiration Needles; Introducing a Novel End Point of Sample Weight Corrected for Blood Content

BackgroundThe use of 22- or 21-gauge (G) endobronchial ultrasound (EBUS) needles are recommended for lung cancer diagnosis and staging. Performance of detailed molecular workup and programmed death ligand 1 (PD-L1) staining in lung cancer patients increases the demand for tissue. The aim of this prospective, randomized two-center trial was to compare 19-G and 22-G EBUS needles regarding tissue quality, diagnostic yield, feasibility, safety, performance, and blood content. Patients and MethodsPatients with a computed tomography scan indicative of lung cancer with mediastinal or hilar lymph node metastases were prospectively enrolled and randomized for the use of either a 19-G or a 22-G EBUS needle. A blood content score from 0 to 2 was applied. Samples were weighed, tumor cells were counted per slide, and complications and final diagnoses were documented. ResultsWe enrolled 107 patients (53 [49.5%] in the 19-G group/54 [50.5%] in the 22-G group) and samples were weighed immediately after performing EBUS. Samples obtained with a 19-G needle contained significantly more tissue (P = .0119). Non–small-cell lung cancer-infiltrated EBUS samples contained significantly more tumor cells when sampled with a 19-G needle (P = .0312). The diagnostic yield was equally adequate in both groups. Four moderate EBUS-related bleedings occurred (2 per group), hemostasis was rapidly achieved in all cases. Further complications did not occur. ConclusionEndobronchial ultrasound-guided transbronchial needle aspirations with a 19-G needle contain significantly more tissue and tumor cells per slide with a safety profile similar to 22-G needles. Further research is needed to investigate the relevance of this finding in terms of molecular analyses and PD-L1 staining.

Selective thoracoscopic intercostal block through a transbronchial aspiration needle: an alternative analgesic tool for pain control after video-assisted thoracic surgery

Selective thoracoscopic intercostal block through a transbronchial aspiration needle: an alternative analgesic tool for pain control after video-assisted thoracic surgery

Role of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration in the Diagnosis of Intraocular Inflammation in India – Our Experience

ABSTRACTPurpose: To report our experience of using Endobronchial ultrasound-guided transbronchial lymph node aspiration (EBUS-TBNA) in assessing the etiology in uveitis from two tertiary eye-care centers in India.Materials & Methods: Retrospective interventional case series.Results: A total of 99 patients of uveitis who underwent EBUS-TBNA were included in the study. Mycobacterium tuberculosis (MTb) was detected on culture in 5 cases, 3 cases by polymerase chain reaction and caseating granulomas in 25 cases. None of these patients had any symptoms of systemic tuberculosis (TB). Biopsy was inconclusive in eight cases. Granulomatous inflammation was seen in 91 cases. In 51 cases, it was difficult to differentiate between sarcoidosis and TB on biopsy. None of the patients had any significant complications. There was a fair agreement between the biopsy diagnosis and the final ocular diagnosis.Conclusions: In high TB endemic countries, procedures like EBUS-TBNA are useful in obtaining tissue diagnosis of TB when ocular diagnosis may be inconclusive due to paucity of ocular tissue.

The value of rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions

IntroductionRapid on-site evaluation (ROSE) is a technique used for immediate interpretation of transbronchial aspirates; there is debate as regards the contribution of ROSE to the diagnostic or staging process in patients with lung cancer undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Aim of the studyThe aim of this study was to evaluate the role of ROSE during EBUS-guided TBNA in the diagnosis of the nature of mediastinal/hilar lesions detected using thoracic computed tomography regardless of whether or not there is a known lung malignancy.Patients and methodsAll patients with hilar/mediastinal lymph nodes having short axis of at least 1 cmon new thoracic computed tomography scan were included. The target lymph node was examined using real-time EBUS B-mode, and then TBNA was performed by inserting a dedicated 22-G needle through the working channel of the bronchoscopy. The samples were examined using the ROSE technique and then compared with the results of the final pathologic diagnosis.ResultsThe current study was conducted on 47 patients (29 male and 18 female) with a age (mean±SD) of 56±15.4 years. EBUS-TBNA was performed for 129 mediastinal lesions in different stations. Among them, 77 of them were diagnosed as malignant initially on performing ROSE. After final histopathological and immunological examination, 74 lesions were proved to be malignant, whereas three lesions turned out to be benign. 52 lesions were diagnosed as benign on ROSE, whereas four of them were proved to be malignant on the final diagnosis, giving ROSE a specificity of 94.12%, sensitivity of 94.87%, and diagnostic accuracy of 94.57%.ConclusionROSE has add-on advantages to EBUS-TBNA in many aspects, increasing diagnostic accuracy of EBUS-TBNA, increasing safety, and providing sufficient samples for subsequent immunocytochemical and molecular analysis.

ES 07.04 Endoscopic Options for Solitary Pulmonary Nodules

World-wide, aside from men in France, Spain and the Netherlands, peripherally located adenocarcinomas have now overtaken squamous cell carcinoma as the predominant lung cancer cell type. With the implementation of lung cancer screening programs using low dose CT and increasing use of CT imaging for clinical investigations, a large number of people are found to have lung nodules. In contrast to symptomatic lung cancer, the size of screening CT detected or incidental lung nodules suspicious of malignancy is much smaller. Over 75% of screening CT detected lung cancers are ≤20 mm with 20% to 47% of the lung cancers found in the first screening CT and 33% to 62% of lung cancers found in annual repeat screening CT are ≤10 mm.1-4 Because of the small size of these lesions, currently only 20% to 34% of screening CT detected lung cancers are diagnosed by endoscopy. The diagnostic yield of bronchoscopic biopsies is modest.1,2 In the real world setting, even with advanced bronchoscopic methods such as navigation bronchoscopy and radial ultrasound, the diagnostic yield of peripheral lung lesions is less than 60%.5,6 Several factors account for the suboptimal diagnostic yield. The diameter of the airways leading to the lesion may be smaller than the 1.4 mm diameter radial EBUS probe. The lesion may be eccentric rather than perpendicular to the biopsy forceps. Removable of the imaging probe from a guide sheath and re-insertion of biopsy forceps or needle may cause displacement or migration of the guide sheath to a different airway. To improve the diagnostic accuracy, other methods are being developed for endoscopic detection and biopsy of peripheral lung lesions ≤20 mm. Bronchoscopic transparenchymal approach to access peripheral lung nodules from more central airways and real time fluoroscopic transbronchial guidance systems are under evaluation.7,8 Flexible 21G peripheral needles are becoming commercially available for transbronchial aspiration or core biopsy. Small optical imaging probes < 0.5 mm that can be inserted within a 21G needle to confirm abnormal pathology in real time using optical frequency domain imaging9,10 or diffuse reflectance spectroscopy before taking a biopsy. These newer endoscopic approaches hold promise to improve diagnostic accuracy while maintaining the advantage of lower complication rates such as pneumothorax and bleeding compares to CT guided transthoracic lung biopsy. 1. National Lung Screening Research Team, Church TR, Black WC, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013 May 23;368(21):1980-91. 2. Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med 2013; 369(10):920-31. 3. McWilliams A, Tammemagi MC, Mayo et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 2013;369:910-9.4. Horeweg N, van Rosmalen J, Heuvelmans MA, et al. Lung cancer probability in patients with CT- detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol. 2014 Nov;15(12):1332-41. 5. Ost DE, Ernst A, Lei X, et al. AQuIRE Bronchoscopy Registry. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med. 2016 Jan 1;193(1):68-77. 6. Ali MS, Trick W, Mba BI, et al. Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis. Respirology. 2017; 22(3):443-453. 7. Herth FJ, Li S, Jiayuan Sun J, Nader D. Bronchoscopic TransParenchymal Nodule Access: Evaluation of safety and feasibility of Archimedes System. Am J Respir Crit Care Med 2017;195:A7597. 8. Stoy SP, Whitten PE, Al-Zubaidi A, Hogarth K. Bronchoscopic peripheral lung nodule navigation by a novel Live fluoroscopic overlay guidance technology. Am J Respir Crit Care Med 2017;195:A2865. 9. Tan KM, Shishkov M, Chee A, et al. Flexible transbronchial optical frequency domain imaging smart needle for biopsy guidance. Biomed Opt Express 2012; 3::1947-1954. 10. Pahlevaninezhad H, Lee AM, A. R, et al. Endoscopic Doppler optical coherence tomography and autofluorescence imaging of peripheral pulmonary nodules and vasculature. Biomedical Optics xpress. 2015; 6(10):4191-9. Endoscopic biopsy

Flexible needle with integrated optical coherence tomography probe for imaging during transbronchial tissue aspiration.

Transbronchial needle aspiration (TBNA) of small lesions or lymph nodes in the lung may result in nondiagnostic tissue samples. We demonstrate the integration of an optical coherence tomography (OCT) probe into a 19-gauge flexible needle for lung tissue aspiration. This probe allows simultaneous visualization and aspiration of the tissue. By eliminating the need for insertion and withdrawal of a separate imaging probe, this integrated design minimizes the risk of dislodging the needle from the lesion prior to aspiration and may facilitate more accurate placement of the needle. Results from in situ imaging in a sheep lung show clear distinction between solid tissue and two typical constituents of nondiagnostic samples (adipose and lung parenchyma). Clinical translation of this OCT-guided aspiration needle holds promise for improving the diagnostic yield of TBNA.

Safety and Efficacy of Endobronchial Ultrasound-Guided Transbronchial Aspiration Using a 19-Gauge Needle

Safety and Efficacy of Endobronchial Ultrasound-Guided Transbronchial Aspiration Using a 19-Gauge Needle

Understanding local performance data for EBUS-TBNA: insights from an unselected case series at a high volume UK center.

We reviewed the diagnostic performance of endobronchial ultrasound transbronchial aspiration (EBUS-TBNA) on an unselected large cohort of patients who underwent the procedure in our institution in the past 3 years and to compare against published standards and existing literature. All consecutive patients who underwent EBUS from January 2013 to December 2015 were included in the retrospective analysis, with a minimum of 6 months of clinico-radiological follow up. For assessing EBUS-TBNA performance, patients were analysed in three subgroups based on the indication for the EBUS-TBNA: in investigation of isolated mediastinal and/or hilar lymphadenopathy (IMHL), in staging of suspected or confirmed non-small cell lung cancer (NSCLC) and in making a tissue diagnosis in suspected thoracic or extrathoracic cancer. For patients subjected to EBUS-TBNA for staging in suspected lung cancer, accuracy of EBUS was measured by its ability to determine the true N2 stage. A total of 1,656 lymph nodes and 138 peribronchial/peritracheal masses were sampled in 940 patients over the study period. The prevalence of reactive lymphadenopathy was 34%. The overall sensitivity to detect pathological disease was 81.6% (95% CI: 74.2-87.6%) whilst NPV was 74.8% (95% CI: 65.2-82.8%). Amongst patients who underwent EBUS-TBNA for staging purposes, the sensitivity for N2 staging was 83.7% (95% CI: 76.2-89.6%) and NPV was 81.6% (95% CI: 73.2-88.2%). The prevalence of N2 disease was 58%. In the subgroup of patients who proceeded to surgical sampling, the sensitivity was higher with the N2/N3 disease prevalence of 67.4%. The sensitivity of EBUS-TBNA to make a tissue diagnosis of thoracic or extrathoracic cancer was 88% (95% CI: 85.1-90.5%) and a NPV of 62% (95% CI: 54.7-69.0%). The disease prevalence was 83.6%. This retrospective study of a large volume of patients represents real life practice and provides an accurate representation of the typical cohort of patients referred in for EBUS-TBNA to the general respiratory physician in UK. Our study highlights the pitfalls in collecting and analyzing data but also demonstrates how they can be used to improve service performance.