Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in solitary mediastinal, hilar lymphadenectasis, or peribronchial lesions: Six cases reports and review of literature

Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing thoracic lesions: a retrospective cohort study

Background

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for biopsy of lung, peri-pulmonary tissue and lymph nodes under real-time ultrasound-guided biopsy. It is used in the diagnosis and/or staging of benign and malignant pulmonary and non-pulmonary diseases. Our study is based on a large sample size, in a diversified population which provides a representative real-world cohort for analysis.

Methods

Patients who underwent EBUS-TBNA procedure between September 2019 and August 2022 were included in this retrospective study. For cases diagnosed as benign and unclassified lesions by EBUS-TBNA, the final diagnosis was determined by further invasive surgery or a combination of therapy and clinical follow-up for at least 6 months.

Results

A total of 618 patients were included in the study, including 182 females (29.4%) and 436 males (70.6%). The mean age of all patients was 61.9 ± 10.5 years. These patients were successfully punctured by EBUS-TBNA to obtain pathological results. The pathological diagnosis results of EBUS-TBNA were compared with the final clinical diagnosis results as follows: 133 cases (21.5%) of benign lesions and 485 cases (78.5%) of malignant lesions were finally diagnosed. Among them, the pathological diagnosis was obtained by EBUS-TBNA in 546 patients (88.3%) (464 malignant lesions and 82 benign conditions), while EBUS-TBNA was unable to define diagnosis in 72 patients (11.6%). 20/72 non-diagnostic EBUS-TBNA were true negative. The overall diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA were 91.3%, 100%, 100%, 27.8%, and 91.6% [95% confidence interval (CI): 89.1-93.6%], respectively. In this study, only one case had active bleeding without serious complications during the EBUS-TBNA procedure.

Conclusion

Given its low invasiveness, high diagnostic accuracy, and safety, EBUS-TBNA is worth promoting in thoracic lesions.

Successful thoracoscopic resection of an esophageal bronchogenic cyst

Esophageal bronchogenic cysts are rare, and since a limited number of cases has been reported, the treatment plan for asymptomatic patients is difficult. A 55-year-old man without any symptoms visited our hospital for further examination of an esophageal mass detected on simple computed tomography. Upper endoscopy showed the protruding, submucosal mass covered by normal mucosa, and endoscopic sonography confirmed hypoechoic lesions originating from the muscularis propria. The patient was diagnosed as having an esophageal duplication cyst and underwent thoracoscopic resection. Pathological findings were consistent with an esophageal bronchogenic cyst. The patient was discharged without any problems on the 6th postoperative day. Upper endoscopy was performed 6 months after surgery, and no evidence of esophageal diverticula or narrowing was present. In conclusion, early thoracoscopic resection of esophageal bronchogenic cysts, before appearance of the symptom, can be a considerable treatment option because it is less invasive and may be advantageous for obtaining a definitive diagnosis in patients who are candidates for safe surgical resection.

Endobronchial ultrasound guided Echo Tip Ultra HD 22G needle versus Echo Tip Pro Core HD 22G needle in diagnosis of mediastinal lesions

Background

Convex probe endobronchial ultrasound is a minimally invasive technique used for performing real-time transbronchial needle aspiration of enlarged hilar and mediastinal lymph nodes and could be used for diagnosing proximal peribronchial lesions. Although computed tomography, magnetic resonant imaging, and positron emission tomography/computed tomography have relatively high sensitivity for mediastinal evaluation, pathology is the gold standard. This study compared between Echo Tip Ultra HD-EBUS 22G needle and Echo Tip ProCore HD-EBUS 22G needle in diagnosis of mediastinal lesions using convex probe endobronchial ultrasound.

Results

Twenty-four patients with mediastinal lesions were included. Convex probe endobronchial ultrasound-guided transbronchial needle aspiration using both Echo Tip Ultra HD 22G and Echo Tip ProCore HD 22G needles was done to all patients with no peripheral lymph node enlargement. CP-EBUS TBNA had diagnostic accuracy 50%, sensitivity 47.6%, and specificity 100% in diagnosis of mediastinal lesions. The Echo Tip Ultra HD needle had diagnostic accuracy 40.9%, sensitivity 38%, and specificity 100% compared to the Echo Tip ProCore HD needle which had diagnostic accuracy 31.8%, sensitivity 82.5%, and specificity 100%. The difference between both needles was statistically insignificant. The Echo Tip Ultra 22G HD needle had more representative cellularity (82%) compared to the Echo Tip ProCore 22G HD needle (45%) with a significant difference between both needles (p value = 0.001).

Conclusion

Both needles can be used equally in sampling mediastinal lesions. This study supports that Echo Tip Ultra HD and Echo Tip ProCore HD needles can be used equally in sampling of mediastinal lesions and supports ultrasound screening of enlarged supraclavicular and cervical lymph nodes before performing EBUS-TBNA in patients with mediastinal lesions.

Ectopic thyroid cancer diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

We report a case of papillary carcinoma in a mediastinal ectopic thyroid diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In this case, the tumor was adjacent to the central airway; therefore, we attempted to perform EBUS-TBNA to obtain specimens for a diagnosis of papillary thyroid carcinoma. Surgical resection was conducted, and histological evaluation of the resected specimen confirmed ectopic papillary thyroid carcinoma, consistent with the histology from the EBUS-TBNA specimen. As a safe and minimally invasive procedure, EBUS-TBNA may be considered for the diagnosis of mediastinal lesions, including papillary carcinoma in mediastinal ectopic thyroid.