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.

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

P1.04-014 Diagnostic Yield in Patients Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of Lung Cancer

P1.04-014 Diagnostic Yield in Patients Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of Lung Cancer

Value of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of the mediastinal enlarged lymph nodes

Objective: To investigate the value of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosing mediastinal enlarged lymph nodes. Methods: A total of 210 patients with mediastinal enlarged lymph nodes from the First Affiliated Hospital of Zhengzhou University from 2014 July to 2015 October were enrolled for EBUS-TBNA. Endobronchial ultrasound (EBUS) imaging features, including lymph node short diameter, the ratio of longitudinal to transverse diameter, the blood flow and morphology destroy, in benign and malignant lymph nodes were evaluated separately and their relationships with the rate of malignant lymph nodes were also analyzed. The significant variables according to single factor analysis were brought into the Logistic multivariate analysis, which investigated the risk factors of malignant lymph nodes. The best cut-off point of the short diameter of lymph nodes was analyzed by receiver operating characteristic curve (ROC). The sensitivity, specificity and accuracy of EBUS-TBNA in the diagnosis of malignant lymph nodes were analyzed by the standard calculation formula. Results: The sensitivity, specificity, accuracy rate of EBUS-TBNA diagnosing lung cancer and other tumor with mediastinal lymph node metastasis were 91.2%, 100%, 93.8%. The rates of malignant in lymph node with short diameter ≥1.0 cm, ratio of longitudinal to transverse diameter<1.5, blood flow distribution Ⅱ-Ⅲ, morphology destroy by the EBUS measurement were higher than those in the lymph node with short diameter<1.0 cm, ratio of longitudinal to transverse diameter ≥ 1.5, the blood flow distribution 0-Ⅰ, without morphology destroy (79.8%, 77.8%, 84.7%, 76.7% vs 37.7%, 44.6%, 42.9%, 42.9%), and the four factors were independent risk factors for malignant lymph nodes (all P<0.001). The ROC curve indicated the optimal cut-off point of short diameter was 8.2 mm. The accuracy of diagnosis by the combination of the above 4 ultrasound features, those were the lymph node short diameter not less than 1 cm, the ratio of longitudinal to transverse diameter less than 1.5, the blood flow distribution Ⅱ-Ⅲ and morphology destroy, was higher than those of the single factor (89.3% vs 74.7%, 67.9%, 67.8%, 67.5%) (all P<0.001). Conclusion: EBUS-TBNA has satisfying value in diagnosing malignant mediastinal enlarged lymph nodes.

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.

Utility of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of intrathoracic lymphadenopathy in patients with human immunodeficiency virus infection.

Objective. Intrathoracic lymphadenopathy (LAD) in patients with Human Immunodeficiency Virus (HIV) infection is common, with wide-ranging diagnoses, from benign to malignant causes. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a relatively new technology with established applications in lung cancer, sarcoidosis, and tuberculosis. We sought to find out whether the addition of EBUS-TBNA to the diagnostic algorithm for LAD in HIV patients will reduce the need for mediastinoscopy. Methods. Retrospective chart review of all EBUS-TBNA procedures performed in our centre from August 2008 to December 2012. Results. 513 patients had EBUS-TBNA performed during this period. We identified nine HIV-infected patients who had LAD of unknown cause and underwent EBUS-TBNA. The procedure reduced the need for mediastinoscopy in eight patients (89%). Conclusions. Potential mediastinoscopies can be avoided by utilising EBUS-TBNA in HIV patients with LAD.

Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis of sarcoidosis in clinically unselected study populations.

Literature suggests that ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has excellent performance characteristics for diagnosis of sarcoidosis. However, many authors challenge the external validity of EBUS-TBNA results, as most studies were performed in referral centres by highly experienced investigators, and included populations with very high sarcoidosis prevalence. We performed a systematic review and meta-analysis to estimate the role of EBUS-TBNA for diagnosis of sarcoidosis in studies enrolling consecutive patients with lymphadenopathy detected at imaging studies, regardless of the suspected underlying clinical aetiology. The Pubmed, Embase, Cinahl, Web of Science and Cochrane Library databases were screened to identify the pertinent literature. Quality of eligible studies was assessed by Quality Assessment, Data Abstraction and Synthesis-2 criteria. Pooled diagnostic yield, sensitivity and specificity were calculated, and a summary receiver operating characteristic curve was constructed. Subgroup analysis was planned to identify possible sources of study heterogeneity. Fourteen studies, collectively involving 2097 patients, fulfilled eligibility criteria. The median prevalence of sarcoidosis was 15%. EBUS-TBNA had a pooled diagnostic yield of 0.79 (standard deviation, 0.24), a pooled sensitivity of 0.84 (95% confidence interval (CI), 0.79-0.88) and a pooled specificity of 1.00 (95% CI, 0.99-1.00). Only subgroup analysis exploring the influence of study design seemed to influence the observed inter-study heterogeneity for sensitivity, retrospective studies showing worst sensitivity than prospective ones. The results of EBUS-TBNA for diagnosis of sarcoidosis in clinically unselected populations are excellent and compare favourably with published results from studies conducted in selected populations. High-quality trials would be needed to evaluate factors possibly explaining the observed heterogeneity in sensitivity.

The predictive value of gray scale sonographic features in malignant hilar and mediastinal lymph node

To explore the sonographic features of malignant hilar and mediastinal lymph nodes and the predictive value. We performed retrospective analysis of 390 lymph nodes under the endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis in the bronchoscope center of the First Affiliated Hospital of Guangzhou Medical University from November 1st, 2012 to November 31st, 2013. They were divided into malignant and benign groups, and sonographic features of lymph nodes were analyzed, including the length of short axis, shape, margin, echogenicity, homogenicity, coagulation necrosis, calcification, coalesence and posterior acoustic enhancement. A total of 390 lymph nodes were evaluated, including 207 malignant and 183 benign lymph nodes, respectively. The accuracy based on the length of short axis, shape, margin, echogenicity, homogenicity, coagulation necrosis, calcification, coalesence and posterior acoustic enhancement to predict the malignancy were 61.0% (238/390), 75.4% (294/390), 75.6% (295/390), 73.8% (288/390), 65.9% (257/390), 68.2% (266/390), 51.8% (202/390), 55.1% (215/390), 67.4% (263/390), respectively. Binary multivariable logistic regression analysis revealed that 5 parameters, including round, distinct margin and heterogeneous, hypoechoic, and posterior acoustic enhancement possessed a significant predictive value(P < 0.05).We found that only 35.3% (73/207) malignant lymph nodes possessed these 5 ultrasonographic characteristics, and the diagnosis rate was 93.6% (73/78).72.46% (150/207) malignant lymph nodes possessed any 4 or more positive sonographic features, and the diagnosis rate was 85.2% (150/176).85.0% (176/207) malignant lymph nodes had any 3 or more positive sonographic features, and the diagnosis rate was 84.6% (176/208). The combination of gray scale sonographic features has a predictive value in the diagnosis of malignant hilar and mediastinal lymph nodes.

M14 Role of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of isolated mediastinal lymphadenopathy (IML)

Introduction and ObjectivesThe recognition of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as an important diagnostic modality has been increasing in recent years, particularly following establishment of its use in lung...

Usefulness of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of Sarcoidosis

PurposeEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate and minimally invasive technique used routinely for investigation of mediastinal and hilar lymphadenopathy. However, few studies have addressed its role in comparison to the traditional diagnostic approaches of transbronchial lung biopsy (TBLB), endobronchial biopsy (EBB), and bronchoalveolar lavage (BAL) in the diagnosis of sarcoidosis. We evaluated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis compared to TBLB, EBB, and BAL.Materials and MethodsConsecutive patients with suspected sarcoidosis (stage I and II) on chest radiography and chest computed tomography were included. All 33 patients underwent EBUS-TBNA, TBLB, EBB, and BAL during the same session between July 2009 and June 2011. EBUS-TBNA was performed at 71 lymph node stations.ResultsTwenty-nine of 33 patients, were diagnosed with histologically proven sarcoidosis; two patients were compatible with a clinical diagnosis of sarcoidosis during follow-up; and two patients were diagnosed with metastatic carcinoma and reactive lymphadenopathy, respectively. Among 29 patients with histologically proven sarcoidosis in combination with EBUS-TBNA, TBLB, and EBB, only EBUS-TBNA and TBLB revealed noncaseating granuloma in 18 patients and one patient, respectively. The overall diagnostic sensitivities of EBUS-TBNA, TBLB, EBB, and BAL (CD4/CD8 ≥3.5) were 90%, 35%, 6%, and 71%, respectively (p<0.001). The combined diagnostic sensitivity of EBUS-TBNA, TBLB, and EBB was 94%.ConclusionEBUS-TBNA was the most sensitive method for diagnosing stage I and II sarcoidosis compared with conventional bronchoscopic procedures. EBUS-TBNA should be considered first for the histopathologic diagnosis of stage I and II sarcoidosis.

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer

Purpose We performed this study to evaluate the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the pathologic diagnosis of lung cancer including lung masses as well as lymph nodes as targets. Methods We retrospectively reviewed 126 patients who underwent EBUS-TBNA to diagnose radiologically suspected lung cancer. The patients had masses or lymph nodes that were highly suspicious for malignancy and accessible by EBUS-TBNA. Results EBUS-TBNA was performed on 195 lesions (lymph nodes, n = 151; lung masses, n = 44). In 61 cases, other diagnostic methods had failed previous to EBUS-TBNA. In 118 patients, no definite endobronchial mucosal tumor invasion was observed. In eight patients with endobronchial tumor invasion, EBUS-TBNA was chosen due to tumor bleeding, necrosis, or difficult location for endobronchial biopsy. EBUS-TBNA confirmed 105 lung cancers, five other malignancies and six specific benign cases, demonstrating a diagnostic yield of 92.1% (116/126). Nine cases were diagnosed by other methods (lung cancer, n = 2; other malignancies, n = 2; benign cases, n = 5). One case that was not confirmed by any diagnostic method was considered false negative. The sensitivity and diagnostic accuracy of EBUS-TBNA in the diagnosis of lung cancer were 97.2% (105/108) and 97.6% (123/126), respectively. Conclusions EBUS-TBNA targeting lymph nodes or masses highly suspicious for malignancy demonstrated high diagnostic value in the diagnosis of lung cancer. EBUS-TBNA is recommended for these cases, especially when other diagnostic methods have failed or are difficult.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of a Mediastinum Mass with Severe Central Airway Obstruction After Stenting

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of a Mediastinum Mass with Severe Central Airway Obstruction After Stenting

Endobronchial Ultrasound-directed Transbronchial Needle Aspiration in Diagnosis of Mediastinal Lesions: Initial Egyptian Experience

Mediastinal lesions represent a diagnostic challenge and often require invasive approaches. We evaluated the role of radial probe endobronchial ultrasound-directed transbronchial needle aspiration (EBUS-TBNA) in the evaluation of mediastinal lesions. Between March 2005 to February 2006, 30 consecutive patients with enlarged mediastinal lymph nodes from unknown etiologies or suspicious for metastatic bronchogenic carcinoma and mediastinal masses underwent EBUS-TBNA and were clinically followed up. EBUS-TBNA was applied under topical anesthesia, midazolam sedation with a mean dose of 4.6+1.7 mg and prolonged the examination by 14.7 minutes on average. EBUS-directed TBNA was performed in 17 lymph nodes and 13 mediastinal masses, achieving specific diagnosis in 82.3% (14/17) and 84.6% (11/13) of examined lesions, respectively, with an overall yield of 83%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant mediastinal lesions were 89.4%, 100%, and 93.3%, respectively. EBUS was well tolerated by most of the patients with no TBNA-related complications. In conclusion, EBUS-TBNA of mediastinal lesions is a minimally invasive safe diagnostic technique with high yield, even in the hands of those with initial experience. This initial study is convincing and stimulating for widespread application of EBUS-TBNA in Egyptian bronchoscopy practice.

Yield of Transbronchial Needle Aspiration in Diagnosis of Mediastinal Lesions

To determine the transbronchial needle aspiration (TBNA) yield for procedures performed by fellows in training, and the predictors of positive TBNA yield at our center. Retrospective chart review. A tertiary teaching hospital. One hundred seventy patients who underwent fiberoptic bronchoscopy with TBNA of mediastinal lesions from January 1991 to July 1999. Final diagnoses were available for 166 patients. TBNA was diagnostic in 104 patients (61%) and nondiagnostic in 66 patients (39%). Of 170 cases, 123 patients (72%) had malignancies, 30 patients (18%) had benign disease, and 13 patients (8%) were normal. Of 123 malignancies, 85 patients (69%) had a positive result by TBNA. Of 30 cases with benign disease, 11 patients (37%) had positive TBNA findings. Eight of 13 patients (62%) with a normal diagnosis had diagnostic TBNA (normal lymphoid tissue). There were statistically significant correlations between TBNA result and cell type of the lesion (p < 0.001), size of the lesion (p < 0.05), and type of malignancy (small cell carcinoma more than non-small cell carcinoma more than lymphoma, p < 0.05). We did not find any significant difference for aspiration yield between carinal and tracheal sites (p > 0.05). Logistic regression analysis indicated that the presence of malignancy is the major determinant of TBNA yield (p = 0.009). In addition, lesion size does affect yield after being adjusted for diagnosis (one-sided p = 0.04). TBNA is a minimally invasive diagnostic technique with a high yield, even in hands of less experienced operators. Malignancy, lesion size, and type of malignancy are major determinants of TBNA yield.

Transbronchial Needle Aspiration for Diagnosis of Lung Cancer

Thirty-two consecutive patients with mediastinal lesions suggestive of bronchogenic carcinoma underwent transbronchial needle aspiration. Eighteen of 20 patients (90 percent) with proved bronchogenic carcinoma had malignant cytology specimens or tissue fragments. Of 12 patients with normal cytology specimens, six were subsequently proved to have nonneoplastic disease. Transbronchial needle aspiration appears to offer a sensitive and specific alternative to more invasive surgical techniques used in the diagnosis of malignancies with mediastinal involvement.