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Tang CL, Zhu Z, Zhong CH, Zhou ZQ, Zhou HQ, Geng RM, Chen XB, Chen Y, Li SY. Clinical application of endobronchial ultrasonography-guided transbronchial needle aspiration biopsy-a single center, large sample, real-world study. BMC Pulm Med 2023; 23:336. [PMID: 37689634 PMCID: PMC10492366 DOI: 10.1186/s12890-023-02568-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Endobronchial ultrasonography-guided transbronchial needle aspiration biopsy (EBUS-TBNA) has been used for more than 10 years in China. Its clinical application and diagnostic value in different diseases with large sample was lack of report. METHODS A retrospective analysis was performed about the application and diagnostic value of EBUS-TBNA in different disease of patients in Respiratory Intervention Center of Guangzhou Institute of Respiratory Health from January 2012 to July 2020. RESULTS A total 5758 patients were included with 182 patients excluded for lack of information. Finally, data of 5576 patients (3798 males and 1778 females) were analyzed. For anesthetize, most patients were undergoing general anesthesia of intravenous with spontaneous breathing (69.4%), followed by general anesthesia of intravenous and inhalation with tracheal intubation and mechanical ventilation (17.9%) and conscious sedation and analgesia (12.8%). Lymph nodes were the main sites of biopsy obtained (76.4%). Tumors accounted for the highest proportion of disease (66.4%), followed by infection diseases (9.9%), sarcoidosis (3.9%), lymphoma (1.1%), and others (18.7%). The sensitivity of EBUS-TBNA for diagnosis of tumor was 89.7%, and 40.8% for infection diseases. There were significant differences in the puncture site and proportions of diseases between male and females (both p < 0.05). Higher diagnostic value was found in male patients (p < 0.05). CONCLUSION EBUS-TBNA has good diagnostic value for different mediastinal and central pulmonary space-occupying lesions diseases, with highest sensitivity for tumors. Higher diagnostic value was found in male patients.
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Affiliation(s)
- Chun-Li Tang
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zheng Zhu
- Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, Guangzhou, China
| | - Chang-Hao Zhong
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zi-Qing Zhou
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Hui-Qi Zhou
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Rong-Mei Geng
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Xiao-Bo Chen
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Shi-Yue Li
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China.
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Bonert M, Zafar U, Ramadan S, Finley C, Cutz JC, Foster G, Ask K, Naqvi A. The physician factor and anatomical site in 8846 consecutive mediastinal lymph node aspirations in a cross-sectional study. Sci Rep 2023; 13:1784. [PMID: 36720994 PMCID: PMC9889352 DOI: 10.1038/s41598-022-26962-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/22/2022] [Indexed: 02/02/2023] Open
Abstract
Mediastinal lymph node fine needle aspiration (MLN-FNA) is a common procedure; however, the physician factor in pathological category, and anatomical site are not routinely assessed. Cytology reports for endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS) MLN-FNA specimens (8846) were retrieved for July 2012-Dec 2019, classified by hierarchical free text string match algorithm into 51 diagnostic categories, four mutually exclusive diagnostic groups (benign |suspicious |malignant |insufficient), and 24 anatomical sites. Pathologist and submitting physician/surgeon bias were assessed using logistic regression and funnel plots|control charts centered on the group median (diagnostic/capture) rate. Eleven pathologists and seven submitting physician/surgeon were involved in more than 250 specimens each. Overall, the MLN-FNAs were benign|suspicious|malignant|insufficient in 46%|4%|25%|24% of specimens. Percent malignant (number of samples) varied by station; 7| 4R| 4L| 2R| 10R| 11R| 11L were respectively 21%(3,101), 27%(2,453), 19%(1,289), 41%(435), 27%(497), 24%(357), 26%(229). The number of outlier (P < 0.05/P < 0.001) pathologists of 11 from the group median rate for benign|suspicious|malignant|insufficient was 0/0| 3/1| 0/0| 3/0 respectively. The outlier (P < 0.05/P < 0.001) submitting physicians/surgeons of 7 for benign|suspicious|malignant|insufficient was 3/2| 2/2| 3/2| 3/2 respectively. The physician and anatomical site are significant predictors of MLN-FNA pathology.
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Affiliation(s)
- Michael Bonert
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Uzma Zafar
- Department of Pathology, Rutgers Health/St. Barnabas Medical Center, Livingston, NJ, USA
| | - Soha Ramadan
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Christian Finley
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, L8S 4L8, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Jean-Claude Cutz
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Gary Foster
- Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Kjetil Ask
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Asghar Naqvi
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. .,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Effect of Needle Size on Diagnosis of Sarcoidosis with Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2022; 19:279-290. [PMID: 35103562 DOI: 10.1513/annalsats.202103-366oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Sarcoidosis is a multisystem disease characterized by noncaseating granulomatous inflammation that most commonly involves the lungs. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an invaluable tool in the assessment of patients with mediastinal and/or hilar lymphadenopathy. Objective: It has been hypothesized that use of the larger 19-gauge (G) needle with EBUS-TBNA improves diagnostic sensitivity in sarcoidosis. However, it is unclear whether the existing literature supports this supposition. Data Sources: A literature search of Embase and Medline was performed by two reviewers. Included articles were evaluated for bias using the QUADAS-2 tool. Data Extraction: For quantitative analysis, we performed a meta-analysis using a binary random-effects model to determine pooled sensitivity. Subgroup analysis was performed based on needle size, use of rapid on-site evaluation (ROSE), study design, and prevalence of sarcoidosis in study group. Synthesis: Sixty-five studies with a total of 4,242 patients were included in the meta-analysis. Overall pooled sensitivity for diagnosis of sarcoidosis was 83.99% (95% confidence interval [CI], 81.22-86.53) among all studies. The 19G subgroup had a significantly higher sensitivity (93.73%; 95% CI, 89.72-97.74%; I2 = 0.00%; P < 0.01) compared with the 21G subgroup (84.61%; 95% CI, 78.80-90.42%; I2 = 69.83%), 22G subgroup (84.07%; 95% CI, 80.90-87.24%; I2 = 85.21%) or unspecified 21G/22G subgroup (78.85%; 95% CI, 70.81-86.90%; I2 = 84.47%). There were no significant differences with use of ROSE or prevalence of sarcoidosis or by study design. Conclusions: The use of 19G needles during EBUS-TBNA had the highest diagnostic sensitivity based on available studies. Further randomized controlled trials using 19G needles should be considered in patients with suspected sarcoidosis.
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Visser MPJ, van Grimbergen I, Hölters J, Barendregt WB, Vermeer LC, Vreuls W, Janssen J. Performance insights of endobronchial ultrasonography (EBUS) and mediastinoscopy for mediastinal lymph node staging in lung cancer. Lung Cancer 2021; 156:122-128. [PMID: 33931293 DOI: 10.1016/j.lungcan.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endobronchial Ultrasonography (EBUS) and mediastinoscopy are used for mediastinal lymph node staging in patients with suspected non-small cell lung carcinoma (NSCLC). In our hospital, confirmatory mediastinoscopy has been largely abandoned, which may reduce the number of surgical interventions and health care costs. This study provides insight into EBUS and mediastinoscopy performance in patients with proven NSCLC from January 2007 until January 2019. METHODS This is a single-centre, retrospective study, evaluating unforeseen N2 rates, negative predictive value and survival, providing insight into the diagnostic yield of EBUS and mediastinoscopy. Surgical lung resection with lymph node dissection was used as reference. RESULTS A total of 418 patients with proven NSCLC after lung resection (mean age: 66 years; 61 % male) and 118 patients who underwent mediastinoscopy, have been included in the study. The overall prevalence of N2 metastases after lung resection was 10.5 %. The percentage of unforeseen N2 cases after negative EBUS was 14.5 %, and 14.3 % after negative mediastinoscopy. Over the past nine years, none of the confirmatory mediastinoscopies were tumor positive after negative EBUS results. The median survival in patients with surgically confirmed N2 metastases was 33 months, compared to 23 months in patients with EBUS/mediastinoscopy-proven N2 metastases. CONCLUSION Despite optimisation of mediastinal staging procedures, it remains difficult to identify all patients with N2 metastases in the workup of NSCLC. In our institute, confirmatory mediastinoscopy has no added value after tumor-negative EBUS procedures, and has been abandoned as standard procedure.
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Affiliation(s)
- M P J Visser
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands.
| | - I van Grimbergen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - J Hölters
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - W B Barendregt
- Department of Surgery, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - L C Vermeer
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - W Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - J Janssen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
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Shin HJ, Kim MS, Kho BG, Park HY, Kim TO, Park CK, Oh IJ, Kim YI, Kim YC, Choi YD, Lim SC. Delayed diagnosis of lung cancer due to misdiagnosis as worsening of sarcoidosis: a case report. BMC Pulm Med 2020; 20:71. [PMID: 32199453 PMCID: PMC7085152 DOI: 10.1186/s12890-020-1105-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The concurrence of sarcoidosis and primary lung cancer is very rare. We report a very rare case with a delayed diagnosis of primary lung cancer due to its misdiagnosis as worsening of pulmonary sarcoidosis. CASE PRESENTATION A 68-year-old man presented to the outpatient department for evaluation of a mass in the right hilar area with lymphadenopathies in subcarinal and both interlobar areas on chest computed tomography (CT). Sufficient core samples were obtained from subcarinal and bilateral interlobar lymph nodes using endobronchial ultrasonography (EBUS) guided transbronchial needle aspiration (TBNA). EBUS could not reach the right hilar lymph node due to its high angle. The pathologic findings were consistent with sarcoidosis. After 5 months, chest CT revealed aggravation of the right upper paratracheal lymphadenopathy. Assuming worsening of sarcoidosis, he was prescribed an oral corticosteroid for 5 months. However, follow-up chest CT showed a newly developed right lower paratracheal lymphadenopathy and worsening right hilar lymphadenopathy. Bronchoscopy and EBUS were performed once again. Transbronchial lung biopsy from the right upper lobe and EBUS-TBNA from the right lower paratracheal lymph node revealed adenocarcinoma from the lung. CONCLUSIONS Although coexistence of sarcoidosis and lung cancer is very rare, the clinician should consider the possibility of accompanying lung cancer in sarcoidosis patients who are not responding to initial corticosteroid therapy.
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Affiliation(s)
- Hong-Joon Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min-Seok Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bo Gun Kho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ha Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Tae-Ok Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Cheol-Kyu Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
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Varela G, Jiménez MF. Dissection of the left paratracheal area is frequently missed during left side non-small cell lung cancer surgery. J Thorac Dis 2019; 11:S1226-S1228. [PMID: 31245092 DOI: 10.21037/jtd.2019.03.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Salamanca, Spain
| | - Marcelo F Jiménez
- Thoracic Surgery Service, Salamanca University Hospital, Salamanca, Spain
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Nardecchia E, Cattoni M, Dominioni L. Endobronchial ultrasound-transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: variability of results and perspectives. J Thorac Dis 2017; 9:S418-S424. [PMID: 28603655 DOI: 10.21037/jtd.2017.04.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The remarkable value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging of non-small cell lung cancer (NSCLC) is recognized worldwide. Reports from different centers however show considerable variation of EBUS-TBNA performance in terms of diagnostic yield, sensitivity and negative predictive value (NPV). Interpretation of EBUS-TBNA diagnostic efficacy requires clarifying whether the technique is used for purely diagnostic purpose or mediastinal staging, recognizing that different study groups may be inherently heterogeneous and that numerous factors may impact on the procedure outcomes. Review of these factors indicates that the prevalence of N2/N3 disease, the thoroughness of mediastinal sampling and >3 needle passes per target lymph node (LN) [in the absence of rapid on-site evaluation (ROSE)] influence the procedure outcomes, while many details in the sample preparation technique are unlikely to impact on the results and should be left to the proceduralists' preference. Generalized use of a standardized database for prospective collection of relevant EBUS-TBNA data would allow reporting institutional results by sub-groups of N2/N3 disease prevalence and thoroughness of staging, and would help establishing quality standards for the procedure.
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Affiliation(s)
- Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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