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Tang N, Tao T, Bao XL. Endobronchial ultrasound-guided cautery-assisted transbronchial mediastinal cryobiopsy in the diagnosis of fibrosing mediastinitis secondary to atypical sarcoidosis: a case report. AME Case Rep 2024; 8:49. [PMID: 38711901 PMCID: PMC11070980 DOI: 10.21037/acr-23-160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/25/2024] [Indexed: 05/08/2024]
Abstract
Background Fibrosing mediastinitis (FM) secondary to atypical sarcoidosis (atypical presentation of sarcoidosis) is rarely reported at home and abroad. Its clinical manifestations represent a lack of specificity, and the initial diagnosis is frequently difficult. In particular, this case has multiple pulmonary nodules with mediastinal lymph node enlargement and bilateral pleural effusion, and pulmonary fibrosis still exists after treatment, which is inconsistent with any clinical stage of pulmonary sarcoidosis, further increasing the diagnostic difficulty. We retrospectively analyzed the clinical data of a case of FM secondary to atypical sarcoidosis diagnosed by endobronchial ultrasound-guided cautery-assisted transbronchial mediastinal cryobiopsy (EBUS-CA-TBMCB) in Chongqing University Fuling Hospital, to improve clinicians' attention to FM and understand that EBUS-CA-TBMCB remains an effective way of etiological diagnosis. Case Description A 70-year-old man was hospitalized with cough and dyspnea for two months. After admission, through chest computed tomography (CT), ultrasound guided bilateral lung biopsy, left parietal pleural biopsy, and EBUS-CA-TBMCB, the final diagnosis was atypical sarcoidosis secondary FM. After taking glucocorticoid orally, the patient's condition improved significantly, and was discharged from the hospital. We continued following up outside the hospital, and the patient's condition was further improved. Conclusions The diagnosis of FM is mainly based on typical imaging manifestations. When the contrast-enhanced chest CT finds localized or diffuse soft tissue density shadows around the mediastinum and pulmonary hilum with an irregular shape, with or without calcification, particular attention should be paid to exclude FM. EBUS-CA-TBMCB, as an improved minimally invasive method, can obtain enough tissue samples for pathological diagnosis, which may be the effective biopsy method for the etiology of FM to avoid missed diagnosis and misdiagnosis in the future.
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Affiliation(s)
- Nan Tang
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, China
| | - Tao Tao
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, China
| | - Xiao-Li Bao
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, China
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Benzaquen S, Matta A, Sultan S, Sarvottam K. Role of Bronchoscopy in Diagnosis of Sarcoidosis. Clin Chest Med 2024; 45:25-32. [PMID: 38245368 DOI: 10.1016/j.ccm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a multisystem inflammatory disorder with unclear etiology and can often pose a diagnostic challenge. A tissue diagnosis is often necessary to illustrate the non-caseating granulomas on histopathology. This review aims to synthesize current evidence related to tissue diagnosis of sarcoidosis using various bronchoscopic techniques. We start by discussing standard bronchoscopic techniques which have remained the cornerstone of diagnostic workup such as bronchoalveolar lavage (BAL), endobronchial biopsy (EBB), conventional transbronchial needle aspiration (cTBNA) and transbronchial lung biopsy (TBLB) followed by newer modalities that incorporate real-time image guidance using endobronchial and endoscopic ultrasound. Although BAL, EBB, and TBLB have been employed as a diagnostic tool for several decades, their sensitivity and diagnostic yield is inferior to ultrasound-based endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). More recently, convincing evidence has also emerged to support the diagnostic accuracy and tissue yield of transbronchial lung cryobiopsy which will also be discussed in this review. These advances in bronchoscopic equipment and techniques over the last 2 decades have made it possible to obtain tissue samples using minimally invasive techniques thus avoiding invasive open lung biopsy and the risks that inherently follow. Up-to-date knowledge of these modalities is imperative for ensuring evidence-based medicine and improving patient-centric outcomes.
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Affiliation(s)
- Sadia Benzaquen
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Atul Matta
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sahar Sultan
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kumar Sarvottam
- Division of Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Al Sona M, Esivue O, Benzaquen S. Endobronchial ultrasound (EBUS)-guided transbronchial miniforceps biopsy an urban center experience. J Thorac Dis 2024; 16:183-190. [PMID: 38410576 PMCID: PMC10894409 DOI: 10.21037/jtd-23-884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in staging mediastinal and hilar lymph nodes in non-small cell lung cancer (NSCLC) is well established. However, evidence of its diagnostic utility in other pathologies-such as lymphoma-remains inadequate. This retrospective observational study aims to determine the diagnostic yield of EBUS-guided miniforceps biopsy (EBUS-MFB) compared to EBUS-TBNA in both malignant and nonmalignant conditions. Methods We conducted a retrospective cross-sectional chart review of all adult patients referred for EBUS at our institution between January 2019 and December 2022. All patients who underwent both EBUS-TBNA and EBUS-MFB were included, with some patients also undergoing transbronchial cryobiopsy. Patients without pathology reports available were excluded. Results The combination of EBUS-MFB and EBUS-TBNA had the highest percentage of diagnostic results both in the overall cohort (34.4%) and in patients who did not undergo transbronchial cryobiopsy (46.2%). EBUS-MFB alone yielded more diagnostic results compared to EBUS-TBNA. Transbronchial cryobiopsy was the sampling method with the highest percentage of diagnostic results in the cryobiopsy group (64.5%). Statistical analysis revealed a significant difference in diagnostic yield between EBUS-MFB and EBUS-TBNA (P<0.001), with EBUS-MFB showing a higher diagnostic yield overall. EBUS-MFB had a significantly higher diagnostic yield than EBUS-TBNA in benign cases, in patients diagnosed with sarcoidosis, but not in malignant disease. Conclusions Our study suggests that combining EBUS-MFB with EBUS-TBNA can improve the diagnostic yield, particularly in benign cases and sarcoidosis. These findings support the potential superiority of adding EBUS-MFB over EBUS-TBNA alone and highlight the need for further randomized control trials to validate these results. The retrospective nature of this study and certain limitations, such as the lack of adequate longer-term follow-up, selection and operator biases, and the absence of rapid on-site evaluation (ROSE) in some cases, should be considered when interpreting the results. Nonetheless, this study contributes to the growing evidence for the utility of EBUS-MFB in improving the diagnostic yield of EBUS procedures in specific clinical scenarios.
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Affiliation(s)
| | - Oshioke Esivue
- Department of Pulmonary and Critical Care, Albert Einstein Medical Center, Philadelphia, PA, USA
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Ramarmuty HY, Oki M. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: a narrative review. Mediastinum 2023; 8:2. [PMID: 38322189 PMCID: PMC10839513 DOI: 10.21037/med-23-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 02/08/2024]
Abstract
Background and Objective Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe, and well-established method for diagnosing and staging lung cancer and other conditions associated with mediastinal lymphadenopathy. Efforts have been made to enhance the material adequacy of EBUS-TBNA, including the recent introduction of EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TMC). This advancement facilitates the acquisition of larger and better-preserved tissue samples from the mediastinum. We evaluated the diagnostic accuracy and safety of EBUS-TMC in the diagnosis of malignant lesions and its effectiveness in relation to benign conditions, such as tuberculosis and sarcoidosis. Methods We searched the PubMed® database for relevant English articles published up to July 1, 2023. Subsequently, we conducted a comprehensive bibliographic analysis with a particular emphasis on diagnostic yield, safety profile, and procedural technicalities. Key Content and Findings Our narrative review, comprising seven publications, emphasizes the significance of EBUS-TMC as an effective technique for obtaining diagnostic tissue in malignant and benign conditions while maintaining an excellent safety profile. Furthermore, its capability for obtaining larger tissue samples facilitates molecular and immunological analysis in non-small cell lung cancer. Conclusions EBUS-TMC exhibits significant efficacy with regard to obtaining diagnostic tissue in malignant and benign conditions. However, further studies are needed to evaluate uncertainties regarding the selection of suitable cases and technical intricacies.
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Affiliation(s)
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Christiansen IS, Bodtger U, Nessar R, Salih GN, Kolekar S, Sidhu JS, Høegholm A, Laursen CB, Arshad A, Clementsen PF. Safety and feasibility of oesophageal ultrasound for the work-up of thoracic malignancy in patients with respiratory impairment. J Thorac Dis 2023; 15:3965-3973. [PMID: 37559642 PMCID: PMC10407489 DOI: 10.21037/jtd-22-1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/02/2023] [Indexed: 08/11/2023]
Abstract
Biopsying lung tumours with endobronchial access in patients with respiratory impairment is challenging. However, fine needle aspiration with the endobronchial ultrasound-endoscope via the oesophagus (EUS-B-FNA) makes it possible to obtain tissue samples without entering the airways. Safety of EUS-B-FNA in these patients has not earlier been investigated prospectively. Therefore, this study aimed at assessing feasibility and safety of EUS-B-FNA from centrally located tumours suspected of thoracic malignancy in patients with respiratory insufficiency. The study is a prospective observational study. Patients with indication of EUS-B-FNA of centrally located tumours and respiratory impairment defined as modified Medical Research Council (mMRC) dyspnoea scale score of ≥3, saturation ≤90% or need of continuous oxygen supply were included prospectively in three centres. Any adverse events (AEs) were recorded during procedure and 1-hour recovery. AEs were defined as hypoxemia (saturation <90% or need for increased oxygen supply) or any kind of events needing intervention. Late procedure-related events were recorded during 30-day follow-up. Between April 1, 2020 and January 30, 2021, 16 patients were included. No severe AEs (SAEs) occurred, but AEs were seen in 50% (n=8) and 13% (n=2) of the patients during procedure and recovery respectively. AEs included hypoxemia corrected with increased oxygen supply and in two cases reversal of sedation. Late procedure-related events were seen in 13% (n=2) and included prolonged need of oxygen and one infection treated with oral antibiotics. In this cohort, EUS-B-FNA of centrally located tumours was safe and feasible in patients with respiratory impairment, when examined in the bronchoscopy suite. A variety of mostly mild and manageable complications may occur, a few even up to 30 days post-procedure.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Rafi Nessar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Shailesh Kolekar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Jatinder Sing Sidhu
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Asbjørn Høegholm
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
| | - Christian B. Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Arman Arshad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Paul Frost Clementsen
- Respiratory Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
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Wang Y, Zhao Z, Zhu M, Zhu Q, Yang Z, Chen L. Diagnostic value of endobronchial ultrasound elastography in differentiating between benign and malignant hilar and mediastinal lymph nodes: a retrospective study. Quant Imaging Med Surg 2023; 13:4648-4662. [PMID: 37456274 PMCID: PMC10347355 DOI: 10.21037/qims-23-241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 07/18/2023]
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a first-line approach for diagnosing hilar and mediastinal lymph node metastasis. Endobronchial ultrasound (EBUS) elastography is an imaging technique for describing the elasticity of intrathoracic lesions. However, the reported accuracy of EBUS elastography needs to be improved. In this study, we aimed to explore the diagnostic value of EBUS elastography for differentiating between benign and malignant hilar and mediastinal lymph nodes. Methods We conducted a single-center, retrospective study enrolling consecutive patients who received EBUS elastography followed by EBUS-TBNA at the Chinese PLA General Hospital from October 2015 to October 2022. The pathological results of EBUS-TBNA confirmed by 6-month follow-up were used as the gold standard. The ultrasound elastography parameters of lymph nodes included strain rate, stiff area ratio, and elasticity score, along with the conventional ultrasound characteristics such as short axis diameter, shape, margin, echogenicity distribution and intensity, and blood flow. The diagnostic performance of these parameters was compared, and conjointly analyzed using multivariate logistic regression. Bootstrapping resampling was applied for internal validation of the regression model. Results A total of 83 patients were enrolled with an average age of 57 years, and 66.3% of patients were male. In total, 131 lymph nodes were punctured, among which 79 (60.3%) were malignant. All the conventional ultrasound characteristics were significantly different between benign and malignant lymph nodes. All the ultrasound elastography parameters of malignant lymph nodes were markedly higher than those of benign lymph nodes. Multivariate logistic regression analysis showed that the margin, echogenicity intensity, blood flow, short axis diameter, and stiff area ratio were the main factors affecting the lymph node property. The diagnostic accuracy, sensitivity, and specificity were 91.8% [95% confidence interval (CI): 85.4-96.0%], 94.4% (95% CI: 86.4-98.5%), and 88.0% (95% CI: 75.7-95.5%), respectively. Bootstrap resampling validation showed a concordance index (C-index) of 0.949. The calibration plot indicated good agreement between the predicted and observed results. Conclusions EBUS elastography is a promising approach for differentiating between benign and malignant lymph nodes. The combination of conventional EBUS and elastography can improve diagnostic efficacy, provide reliable complementary information, and guide the implementation of EBUS-TBNA more accurately.
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Affiliation(s)
- Yueming Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Zhao
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Minghui Zhu
- Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiang Zhu
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhen Yang
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Liangan Chen
- School of Medicine, Nankai University, Tianjin, China
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
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Brown MV, Lavrencic K, Badiei A, Jersmann H, Fon A, Chang S, Nguyen P. First Asia-Pacific experience of trans-bronchial core biopsy with a Franseen needle. J Thorac Dis 2023; 15:3273-3284. [PMID: 37426168 PMCID: PMC10323551 DOI: 10.21037/jtd-22-1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/21/2023] [Indexed: 07/11/2023]
Abstract
Background Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the standard for evaluating mediastinal and hilar lesions. EBUS-TBNA is limited by small volume of material obtained for immunohistochemistry (IHC) and ancillary studies important for oncological therapies. The Franseen AcquireTM needle is designed for EBUS-transbronchial needle core biopsy (TBNB) allowing larger core sizes with evidence in gastroenterology literature but little in pulmonology. This study reports the first Asia-Pacific experience of EBUS-TBNB and adequacy of samples for diagnosis and ancillary studies. Methods A retrospective cohort study of EBUS-TBNB at the Royal Adelaide Hospital was conducted between December 2019 and May 2021. Diagnostic rate, adequacy for ancillary studies and complications were evaluated. Samples were flushed into formalin for histological processing with no rapid on-site cytological evaluation (ROSE). For suspected lymphoma, samples were flushed into HANKS for flow cytometry. Cases performed with the Olympus VizishotTM during the same 18-month were similarly analysed. Results One hundred and eighty-nine patients were sampled with the AcquireTM needle. Diagnostic rate was 174/189 (92.1%). Where reported [146/189 (77.2%)], average core aggregate sample size was 13.4 mm × 10.7 mm × 1.7 mm. For non-small cell lung cancer (NSCLC) cases, 45/49 (91.8%) had adequate tissue for programmed cell death-ligand 1 (PD-L1). 32/35 (91.4%) adenocarcinoma cases had sufficient tissue for ancillary studies. There was one false negative malignant lymph node at the first AcquireTM procedure. There were no major complications. One hundred and one patients were sampled with the VizishotTM needle. Diagnostic rate was 86/101 (85.1%) with only 25/101 (24.8%) having reported tissue cores (P<0.0001 of VizishotTM) with the remaining samples processed via cell block. Conclusions AcquireTM EBUS-TBNB diagnostic rate is comparable to historical data with >90% of cases having sufficient core material for ancillary studies. There appears to be a role for the AcquireTM alongside the standard of care for the work up of lymphadenopathy and particularly for lung cancer.
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Affiliation(s)
- Michael V. Brown
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Katherine Lavrencic
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Arash Badiei
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Hubertus Jersmann
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Andrew Fon
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Department of Respiratory and Sleep Medicine, Queen Elizabeth Hospital, Adelaide, Australia
| | | | - Phan Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Wiesel O, Kaufman D, Caplan-Shaw C, Shaw J. Perspective and practice patterns of mediastinal staging among thoracic surgeons. J Thorac Dis 2022; 14:3727-3736. [PMID: 36389296 PMCID: PMC9641344 DOI: 10.21037/jtd-22-183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/17/2022] [Indexed: 01/18/2023]
Abstract
Background Accurate mediastinal staging of lung cancer patients is critical for determining appropriate treatment. Mediastinoscopy and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration are the most commonly utilized techniques. Limited data exist on training and practice trends among thoracic surgeons. We aimed to determine training and practice patterns and find whether there is a paradigm shift in mediastinal staging after the introduction of EBUS into practice among thoracic surgeons in the United States. Methods 28-question survey was constructed querying demographic, training, and practice patterns with mediastinoscopy and EBUS and was sent to practicing thoracic surgeons in the United States. Descriptive statistics were used to summarize quantitative data. Results Ninety-eight responded with a 93% completion rate. Eighty-seven percent of respondents received training in EBUS and 70% perform EBUS routinely. All respondents believe EBUS should be incorporated into thoracic surgery training curriculums. Majority of those who prefer EBUS feel EBUS is safer than mediastinoscopy, allows access to lymph nodes stations or lesions inaccessible by mediastinoscopy and prefer EBUS to avoid re-do mediastinoscopy and in irradiated mediastinum. Majority of those who prefer mediastinoscopy reported they perform more accurate staging compared to EBUS, that mediastinoscopy is more accurate in diagnosing lymphoma or sarcoidosis and that frozen section can be done at the same interval as resection. Among surgeons who prefer EBUS, 94% biopsy 3 or more lymph node stations, 86% routinely biopsy hilar (N1) nodes while 8% never biopsy N1 nodes. Of surgeons who prefer mediastinoscopy. Ninety-seven percent biopsy 3 or more lymph node stations, only 27% routinely biopsy N1 nodes and 70% never biopsy N1 nodes. Conclusions EBUS is used frequently by thoracic surgeons in their practice for mediastinal staging. Methods of obtaining proficiency in EBUS widely varied among surgeons. In addition to mediastinoscopy, dedicated EBUS training should be incorporated into thoracic surgery training curriculums.
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Affiliation(s)
- Ory Wiesel
- The Cardiovascular Institute, Division of Thoracic Surgery, Baruch-Padeh Medical Center of the North, Poriya, Israel;,The Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel
| | - Daniel Kaufman
- Division of General Thoracic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Caralee Caplan-Shaw
- Division of Pulmonary, Critical Care and Sleep Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Jason Shaw
- Division of General Thoracic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
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Dhaliwal I, Kassirian S, Mitchell MA, Qiabi M, Warner A, Louie AV, Wong HH, McDonald CM, Rajchgot J, Palma DA. Endoscopic nodal staging in oligometastatic non-small cell lung cancer (NSCLC) being treated with stereotactic ablative radiotherapy (ENDO-SABR). BMC Cancer 2022; 22:468. [PMID: 35484614 PMCID: PMC9047351 DOI: 10.1186/s12885-022-09563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research in treatment of non-small cell lung cancer (NSCLC) has shown promising results with stereotactic ablative radiotherapy (SABR) of oligometastatic disease, wherein distant disease may be limited to one or a few distant organs by host factors. Traditionally, PET/CT has been used in detecting metastatic disease and avoiding futile surgical intervention, however, sensitivity and specificity is limited to only 81 and 79%, respectively. Mediastinal staging still identifies occult nodal disease in up to 20% of NSCLC patients initially thought to be operative candidates. Endobronchial ultrasound and transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive tool for the staging and diagnosis of thoracic malignancy. When EBUS is combined with endoscopic ultrasound using the same bronchoscope (EUS-B), the diagnostic sensitivity and negative predictive value increase to 84 and 97%, respectively. Endoscopic staging in patients with advanced disease has never been studied, but may inform treatment if a curative SABR approach is being taken. Methods This is a multi-centre, prospective, cohort study with two-stage design. In the first stage, 10 patients with oligometastatic NSCLC (lung tumour ± hilar/mediastinal lymphadenopathy) with up to 5 synchronous metastases will be enrolled An additional 19 patients will be enrolled in the second stage if rate of treatment change is greater than 10% in the first stage. Patients will be subject to EBUS or combined modality EBUS/EUS-B to assess bilateral lymph node stations using a N3 to N2 to N1 progression. Primary endpoint is defined as the rate of change to treatment plan including change from SABR to conventional dose radiation, change in mediastinal radiation field, and change from curative to palliative intent treatment. Discussion If a curative approach with SABR for oligometastatic disease is being explored, invasive mediastinal staging may guide treatment and prognosis. This study will provide insight into the use of endoscopic mediastinal staging in determining changes in treatment plan of NSCLC. Results will inform the design of future phase II trials. Trial registration Clinicaltrials.gov identifier NCT04852588. Date of registration: April 19, 2021. Protocol version: 1.1 on December 9, 2021.
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Affiliation(s)
- Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Shayan Kassirian
- Division of Respirology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael A Mitchell
- Division of Respirology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mehdi Qiabi
- Division of Thoracic Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Andrew Warner
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Alexander V Louie
- Division of Radiation Oncology, Department of Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harvey H Wong
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christine M McDonald
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jason Rajchgot
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
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Abstract
The indications and utility of flexible bronchoscopy have expanded over the past few decades with major innovations in design and development of new tools for endobronchial interventions and image-guided tissue sampling techniques. This review highlights the application of advanced diagnostic bronchoscopy (including endobronchial ultrasound and CT navigational techniques), cryotherapy and the use of one-way endobronchial valves for persistent air leak in the pediatric setting.
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11
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Abstract
Convex probe endobronchial ultrasound (CP-EBUS) has been widely used in the lymph node staging and restaging of lung tumors and the diagnosis of mediastinal diseases. Recent years have seen continuous progress in this technology. For diagnosis, elastography technology can preliminarily distinguish between benign and malignant lesions, so that reduce the number of punctures. CP-EBUS can also be used as an endoscopic ultrasound (EUS) to guide needle aspirations of liver lesions, retroperitoneal lymph nodes and left adrenal gland (LAG) lesions sometimes. Some advances help diagnosing more accurately and effectively, such as the intranodal forceps biopsy (IFB), the new type of 22G needle, the rapid on-site evaluation (ROSE) and the cancer gene methylation, etc. In addition, special advances are being made in diagnosis using artificial intelligence (AI). For treatment, CP-EBUS has yielded novel research results when applied to transbronchial needle injection (TBNI) and radioactive seed implantation in clinical cases, and blocking of the cardiac plexus in animal studies. The next-generation CP-EBUS is also ready for use in the clinic and the technology will be improving continuously. Through this review, we hope to educate clinicians on the latest uses of CP-EBUS and open up further research ideas for readers interested in this technology.
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Affiliation(s)
- Jian Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Cen Wu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chuming Zhou
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Li
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
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12
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Agrawal A, Ghori U, Chaddha U. Response: Endobronchial-ultrasound guided miniforceps biopsy - Need for combined yield with EBUS-TBNA. Respir Med 2020; 167:105922. [PMID: 32421536 DOI: 10.1016/j.rmed.2020.105922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Abhinav Agrawal
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA.
| | - Uzair Ghori
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Udit Chaddha
- Interventional Pulmonology, Division of Pulmonary, Critical Care & Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Abstract
Endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) have changed the landscape of pulmonology. Mediastinal structures beyond the confines of airway walls are visualized in real-time with EBUS, leading to improved accuracy of tissue sampling and diagnostic yield. With the development of various needle sizes ranging from 25-G to 19-G, the sampling of lymph nodes is becoming easier and more commonplace. Yet, certain conditions such as sarcoidosis and lymphoma may still be difficult to diagnose via EBUS-TBNA. Furthermore, in the age of targeted therapy, there are more demands on EBUS-TBNA samples for molecular marker testing and next-generation sequencing. Here, we present a complementary methodology, EBUS-guided intranodal forceps biopsy (EBUS-IFB), for tissue acquisition that may help address these deficiencies. Specifically, we aim to propose indications, contraindications, outline approaches in performing IFB, and provide an overview of the data for this complementary technique.
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Affiliation(s)
- George Cheng
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, NC, USA
| | - Amit Mahajan
- Inova Cardiac and Thoracic Surgery, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Scott Oh
- Division of Pulmonary, Critical Care Medicine, UCLA Medical Center, Santa Monica, CA, USA
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care Medicine, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Alexander Chen
- Division of Pulmonary, Critical Care Medicine, Washington University Hospital, St Louis, MO, USA
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14
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Chaddha U, Hogarth DK, Murgu S. The role of endobronchial ultrasound transbronchial needle aspiration for programmed death ligand 1 testing and next generation sequencing in advanced non-small cell lung cancer. Ann Transl Med 2019; 7:351. [PMID: 31516897 PMCID: PMC6712250 DOI: 10.21037/atm.2019.03.35] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/13/2019] [Indexed: 12/25/2022]
Abstract
Guidelines recommend testing for driver mutations and programmed death ligand 1 (PD-L1) expression at the time of initial diagnosis and during disease progression to help determine prognosis and initiate personalized therapy. In this article we review the updated literature and techniques of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in obtaining adequate tissue for molecular analysis by using next-generation sequencing (NGS) and for assessing PD-L1 expression through immunohistochemistry.
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Affiliation(s)
- Udit Chaddha
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, USA
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, USA
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, USA
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15
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Colella S, Scarlata S, Bonifazi M, Ravaglia C, Naur TMH, Pela R, Clementsen PF, Gasparini S, Poletti V. Biopsy needles for mediastinal lymph node sampling by endosonography: current knowledge and future perspectives. J Thorac Dis 2018; 10:6960-6968. [PMID: 30746242 DOI: 10.21037/jtd.2018.11.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Due to the increasing role of endosonography [endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound-guided fine needle aspiration (EUS-FNA)] in the diagnosis of several lung diseases, the knowledge of technical aspects is mandatory to optimize the success of the procedure. Among those technicalities related to the procedure, the choice of a needle over another one-either in terms of dimension and type-may have a role in the diagnostic process, especially in some diseases such as lymphoproliferative disorders. In this review, we analyze the current knowledge about the biopsy needle for endosonography, providing also some hints for the future.
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Affiliation(s)
- Sara Colella
- Pulmonary Unit, "C. & G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Simone Scarlata
- Geriatrics, Department of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy
| | - Martina Bonifazi
- Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Claudia Ravaglia
- Pulmonology Unit, Department of Thoracic Diseases, G B Morgagni L Pierantoni Hospital, Forli, Italy
| | | | - Riccardo Pela
- Pulmonary Unit, "C. & G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Stefano Gasparini
- Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedali Riuniti, Ancona, Italy
| | - Venerino Poletti
- Pulmonology Unit, Department of Thoracic Diseases, G B Morgagni L Pierantoni Hospital, Forli, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
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16
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Hopkins E, Moffat D, Smith C, Wong M, Parkinson I, Nespolon W, Buckseall J, Hill M, Jersmann H, Nguyen P. Accuracy of rapid on-site evaluation of endobronchial ultrasound guided transbronchial needle aspirates by respiratory registrars in training and medical scientists compared to specialist pathologists-an initial pilot study. J Thorac Dis 2018; 10:3922-3927. [PMID: 30174833 DOI: 10.21037/jtd.2018.06.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Rapid on-site evaluation (ROSE) of endobronchial ultrasound guided transbronchial needle aspirates (EBUS-TBNA) increases diagnostic accuracy but in many institutions requires a specialist pathologist. This study aimed to determine if medical scientists or respiratory registrars could adequately perform ROSE to determine sufficiency of EBUS samples. Methods ROSE was performed on the first two EBUS-TBNA passes per patient by a pathologist, a medical scientist and two respiratory registrars. The medical scientists involved had all previously performed ROSE on over 50 procedures. The two respiratory registrars received cytology education from a pathologist in four separate hour-long training sessions. Each ROSE reviewer recorded whether each sample was sufficient or insufficient. Pathologist interpretation was taken as gold standard. Specific diagnosis was not required. Final diagnosis and the total number of passes were also recorded. This study recruited 25 patients (50 passes) for statistical evaluation. Results Assessment by specialist pathologists deemed 16/50 (32%) to be sufficient and 34/50 (68%) insufficient respectively. Medical scientists were 90% concordant with the pathologist (K =0.774; 95% CI, 0.587-0.961). The two respiratory registrars were 78% (K =0.568; 95% CI, 0.338-0.798) and 72% (K =0.448; 95% CI, 0.222-0.674) concordant, respectively. The mean number of passes per patient was 4.9 (range, 3-7). A diagnosis was established in 21/25 (82%) patients from the first EBUS-TBNA procedures with the remaining four patients requiring a further procedure or monitoring with serial CT scans to establish the diagnosis. Malignancy was found in 14/25 (56%) patients and a benign process in 11/25 (44%) patients. Conclusions Medical scientist review of ROSE samples is not significantly different to a specialist pathologist and is an acceptable alternative. Respiratory registrars are not a realistic alternative for ROSE without more intensive training, which may be difficult to facilitate in addition to existing respiratory training commitments.
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Affiliation(s)
- Emily Hopkins
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - David Moffat
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Caroline Smith
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Michelle Wong
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Ian Parkinson
- Department of Surgical Pathology/Cytopathology, SA Pathology, SA, Australia
| | - Walter Nespolon
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | | | - Madeline Hill
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Hubertus Jersmann
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Phan Nguyen
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
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17
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Seides BJ, Egan JP, French KD, Kovitz KL, Desai NR. Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature. J Thorac Dis 2018; 10:1972-1983. [PMID: 29707354 DOI: 10.21037/jtd.2018.03.49] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Convex probe endobronchial ultrasound (CP-EBUS) and stereotactic body radiotherapy (SBRT) are valuable tools in the diagnosis, staging, and treatment of thoracic malignancies. With widespread clinical adoption, novel uses of CP-EBUS beyond mediastinal diagnosis and staging continue to be discovered. SBRT is an attractive treatment strategy in early-stage lung cancer and oligo-metastatic disease of the chest when a surgical approach is either not feasible or desirable. Accurate application of SBRT is aided by the placement of radio-opaque fiducial markers (FM) to compensate for respiratory cycle movements. We describe eight patients with central thoracic lesions, either known or suspected to be malignant, who underwent EBUS bronchoscopy with lesion sampling and successful intralesional placement of modified FM via our technique, review the existing literature on this topic, and discuss the nuances of coding and billing aspects of FM placement.
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Affiliation(s)
- Benjamin J Seides
- Division of Pulmonary, Critical Care, and Allergy, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John P Egan
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kim D French
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA
| | - Kevin L Kovitz
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Neeraj R Desai
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
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18
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Abstract
Background The current standard methods for detecting pulmonary artery diseases are pulmonary artery enhanced computed tomography (CT) scan and pulmonary arteriography. However, some patients cannot tolerate these procedures for various reasons. The present study aimed to investigate the feasibility and operation process of endobronchial ultrasound (EBUS) in exploring the pulmonary artery. Methods Based on normal contrast-enhanced chest CT images, the sites and process for exploring the pulmonary arteries were established. Then the feasibility of the exploration by the convex probe EBUS were evaluated, and roadmaps for exploration of the pulmonary arteries were drawn. Results Among patients who underwent pulmonary artery exploration, sonograms of the left and right pulmonary artery were obtained by the convex probe EBUS. The above-mentioned pulmonary artery branches can be positioned by means of anatomical markers under the bronchoscopic view and follow a certain route for continuous exploration. Sonograms had a certain degree of identification and can be used as an auxiliary tool for pulmonary artery exploration. Conclusions EBUS can be used to explore the main branches of the pulmonary artery continuously. Therefore, EBUS could be considered as a candidate for the diagnosis of pulmonary artery diseases in a selected group of patients, i.e., patient with contrast allergy or renal failure.
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Affiliation(s)
- Peng Li
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Cen Wu
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wei Zheng
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Li Zhao
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
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19
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Harris K, Oakley E, Bellnier D, Shafirstein G. Endobronchial ultrasound-guidance for interstitial photodynamic therapy of locally advanced lung cancer-a new interventional concept. J Thorac Dis 2017; 9:2613-2618. [PMID: 28932569 DOI: 10.21037/jtd.2017.07.45] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Recent advances in interventional pulmonology led to a significant expansion of the diagnostic and therapeutic role of endobronchial ultrasound. In this paper, we describe a new concept for using endobronchial ultrasound to guide interstitial photodynamic therapy (PDT). For this purpose, we conducted in vitro and in vivo experiments using a phantom and animal models, respectively. A new 0.5 mm optical fiber, with cylindrical diffuser end, was used to deliver the therapeutic light through the 21-gauge endobronchial ultrasound needle. The animal experiments were performed under real-time ultrasonography guidance in mice and rabbits' tumor models. Safe and effective fiber placements and tumor illumination was accomplished. In addition, computer simulation of light propagation suggests that locally advanced lung cancer tumor can be illuminated. This study demonstrates the potential feasibility of this new therapeutic modality approach, justifying further investigation in the treatment of locally advanced lung cancers.
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Affiliation(s)
- Kassem Harris
- Westchester Medical Center, Department of Medicine, Interventional Pulmonary Section, Valhalla, NY, USA.,Department of Medicine, Interventional Pulmonary, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Emily Oakley
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - David Bellnier
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Gal Shafirstein
- Department of Cell Stress Biology, Photodynamic Therapy Center, Roswell Park Cancer Institute, Buffalo, NY, USA
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20
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Munoz ML, Lechtzin N, Li QK, Wang K, Yarmus LB, Lee HJ, Feller-Kopman DJ. Bronchoscopy with endobronchial ultrasound guided transbronchial needle aspiration vs. transthoracic needle aspiration in lung cancer diagnosis and staging. J Thorac Dis 2017; 9:2178-2185. [PMID: 28840019 DOI: 10.21037/jtd.2017.07.26] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In evaluating patients with suspected lung cancer, it is important to not only obtain a tissue diagnosis, but also to obtain enough tissue for both histologic and molecular analysis in order to appropriately stage the patient with a safe and efficient strategy. The diagnostic approach may often be dependent on local resources and practice patterns rather than current guidelines. We Describe lung cancer staging at two large academic medical centers to identify the impact different procedural approaches have on patient outcomes. METHODS We conducted a retrospective cohort study of all patients undergoing a lung cancer diagnostic evaluation at two multidisciplinary centers during a 1-year period. Identifying complication rates and the need for multiple biopsies as our primary outcomes, we developed a multivariate regression model to determine features associated with complications and need for multiple biopsies. RESULTS Of 830 patients, 285 patients were diagnosed with lung cancers during the study period. Those staged at the institution without an endobronchial ultrasound (EBUS) program were more likely to require multiple biopsies (OR 3.62, 95% CI: 1.71-7.67, P=0.001) and suffer complications associated with the diagnostic procedure (OR 10.2, 95% CI: 3.08-33.58, P<0.001). Initial staging with transthoracic needle aspiration (TTNA) and conventional bronchoscopy were associated with greater need for subsequent biopsies (OR 8.05 and 14.00, 95% CI: 3.43-18.87 and 5.17-37.86, respectively) and higher complication rates (OR 37.75 and 7.20, 95% CI: 10.33-137.96 and 1.36-37.98, respectively). CONCLUSIONS Lung cancer evaluation at centers with a dedicated EBUS program results in fewer biopsies and complications than at multidisciplinary counterparts without an EBUS program.
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Affiliation(s)
- Mark L Munoz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Noah Lechtzin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qing Kay Li
- Department of Pathology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - KoPen Wang
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lonny B Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hans J Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David J Feller-Kopman
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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21
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Maekura T, Sugimoto C, Tamiya A, Saijo N, Naoki Y, Koba T, Kimura Y, Matsuda Y, Kanazu M, Takeuchi N, Sasaki Y, Naito Y, Tsuji T, Sugawara R, Kobayashi T, Nakao K, Taniguchi Y, Okishio K, Omachi N, Kasai T, Atagi S. Combination of virtual bronchoscopic navigation, endobronchial ultrasound, and rapid on-site evaluation for diagnosing small peripheral pulmonary lesions: a prospective phase II study. J Thorac Dis 2017; 9:1930-1936. [PMID: 28839991 DOI: 10.21037/jtd.2017.06.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The diagnostic yield of peripheral pulmonary lesions (PPLs) by flexible bronchoscopy (FB) is still insufficient. To improve the diagnostic yield of bronchoscopy, several techniques such as endobronchial ultrasound (EBUS), virtual bronchoscopic navigation (VBN), and rapid on-site evaluation (ROSE) have been examined. The primary purpose of the present study was to evaluate the usefulness of combining EBUS, VBN, and ROSE for diagnosing small PPLs. METHODS Patients with PPLs 30 mm or less on chest computed tomography (CT) were prospectively enrolled. We determined the responsible bronchus for the target lesions using VBN before bronchoscopy was performed. EBUS and ROSE were performed during the examination to determine whether the bronchus and specimen were adequate. On the basis of previous studies, we assumed that the diagnostic yield of 85% among eligible patients would indicate potential usefulness, whereas, the diagnostic yield of 75% would indicate the lower limit of interest. The required number of patients was estimated as 45 for a one-sided α value of 0.2 and a β value of 0.8. The primary study endpoint was the diagnostic yield. RESULTS Between June 2014 and July 2015, we enrolled 50 patients in the present study, and we excluded 5 patients. The total diagnostic yield of 45 PPLs was 77.7%. In cases of lung cancer, the diagnostic yield was 84.2%. The sensitivity, specificity, positive predictive value, and negative predictive value of ROSE were 90.6%, 92.3%, 96.7%, and 80.0%, respectively. The diagnostic yield of PPLs from 20 to 30 mm was 87.5%, and the diagnostic yield of PPLs less than 20 mm was 66.7%. PPLs for which the probe was located within the lesion had the highest diagnostic yield. CONCLUSIONS We could not demonstrate usefulness for diagnosing small PPLs by combining EBUS, VBN, and ROSE. However, combining these techniques may be useful for diagnosing lung cancer.
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Affiliation(s)
- Toshiya Maekura
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Chikatoshi Sugimoto
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Nobuhiko Saijo
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yoko Naoki
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Taro Koba
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yohei Kimura
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yoshinobu Matsuda
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Masaki Kanazu
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Naoko Takeuchi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yumiko Sasaki
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yujiro Naito
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Taisuke Tsuji
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Reiko Sugawara
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Takehiko Kobayashi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Keiko Nakao
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Kyoichi Okishio
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Naoki Omachi
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Takahiko Kasai
- Department of Laboratory Medicine and Pathology, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Shinji Atagi
- Department of Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
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22
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Jeebun V, Harrison RN. Understanding local performance data for EBUS-TBNA: insights from an unselected case series at a high volume UK center. J Thorac Dis 2017; 9:S350-S362. [PMID: 28603645 DOI: 10.21037/jtd.2017.05.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%. CONCLUSIONS 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.
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Affiliation(s)
- Vandana Jeebun
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
| | - Richard Neil Harrison
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
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23
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Abstract
Combined endosonographic lymph node biopsy techniques are a minimally invasive alternative to surgical staging in non-small cell lung cancer and may be superior to standard mediastinoscopy and surgical mediastinal staging techniques. Endosonography allows for the biopsy of lymph nodes and metastases unattainable with standard mediastinoscopy. Standard cervical mediastinoscopy is an invasive procedure, which requires general anesthesia and is associated with higher risk, cost, and major complication rates compared with minimally invasive endosonographic biopsy techniques. Combined endosonographic procedures are the new gold standard in staging of non-small cell lung cancer when performed by an experienced operator.
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Affiliation(s)
- Pravachan V C Hegde
- Fresno Medical Education Program, Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, Division of Pulmonary & Critical Care Medicine, University of California San Francisco (UCSF), 2335 East Kashian Lane, Suite 260, Fresno, CA 93701, USA.
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, University of Montreal, 1560 Sherbrooke Street East, 8e CD, Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada
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24
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Abstract
The field of diagnostic bronchoscopy has been revolutionized in the last decade primarily with the advent of endobronchial ultrasound (EBUS) but also with the addition of multiple different techniques for "guided-bronchoscopy". These advances have had a substantial impact in the management of lung cancer with bronchoscopy now providing both diagnosis and mediastinal staging in a single procedure. EBUS has, in fact, become the first choice for staging of the mediastinum over cervical mediastinoscopy (CM). Although EBUS is now a well-established technique, there are continuous efforts from the scientific community to improve its diagnostic performance, and these will be reviewed in this manuscript. The term "guided-bronchoscopy" was recently coined to describe a myriad of techniques that guide our bronchoscopes or bronchoscopic tools into the periphery of the lungs in addition to our conventional fluoroscopy. Electromagnetic and non-electromagnetic navigation, thin and ultrathin scopes, as well as radial-probe EBUS have collectively increased our yield for smaller peripheral lung lesions and continue to evolve. Despite this improved diagnostic yield, there is still ample room for improvement and newer techniques are under way. With new therapies available for patients with interstitial lung disease, achieving a specific histologic diagnosis is now of paramount importance. Given the high morbidity and mortality of surgical biopsies, bronchoscopic cryobiopsy is being rapidly adopted as a safer and effective alternative, and it is likely going to play a major role in the management of these diseases in the near future. This manuscript we will focus on recent advances in EBUS, guided-bronchoscopy, and the use of cryobiopsy.
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Affiliation(s)
- Philip G Ong
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Labib G Debiane
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Ho CC, Lin CK, Yang CY, Chang LY, Lin SY, Yu CJ. Current advances of endobronchial ultrasonography in the diagnosis and staging of lung cancer. J Thorac Dis 2016; 8:S690-S696. [PMID: 28066671 DOI: 10.21037/jtd.2016.08.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The diagnosis and staging of patients with lung cancer has relied on tissue sampling. Endobronchial ultrasound (EBUS) is a minimally invasive procedure for the rapid and safe acquisition of tissue and can be done easily and repeatedly. EBUS transbronchial needle aspiration (TBNA) is now the standard for diagnosis of mediastinal and hilar lymphadenopathy and should be considered in patients who have a high probability of lymph node metastases without systemic involvement. EBUS also provides guidance for biopsy of peripheral lung lesions. Recent advances of EBUS with new techniques help to improve the diagnostic yield and decrease the complication rate and total procedure time.
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Affiliation(s)
- Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Kai Lin
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, National Taiwan University College of Medicine, Hsin-Chu, Taiwan
| | - Ching-Yao Yang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lih-Yu Chang
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, National Taiwan University College of Medicine, Hsin-Chu, Taiwan
| | - Shu-Yung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Jinshan Branch, National Taiwan University College of Medicine, New Taipei City, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Peeters ST, Dooms C, Van Baardwijk A, Dingemans AMC, Martinussen H, Vansteenkiste J, Decaluwé H, De Leyn P, Yserbyt J, Nackaerts K, De Wever W, Deroose CM, De Ruysscher D. Selective mediastinal node irradiation in non-small cell lung cancer in the IMRT/VMAT era: How to use E(B)US-NA information in addition to PET-CT for delineation? Radiother Oncol 2016; 120:273-8. [PMID: 27291644 DOI: 10.1016/j.radonc.2016.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/21/2016] [Accepted: 05/24/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND FDG-PET-CT-based selective lymph node (LN) irradiation is standard using 3D-conformal techniques for locally advanced NSCLC. With newer techniques (intensity-modulated/volumetric-arc therapy (IMRT/VMAT)), the dose to non-involved adjacent LN decreases, which raises the question whether FDG-PET-CT-delineation is still safe. We therefore evaluated the impact of adding linear endosonography with needle aspiration (E(B)US-NA) to FDG-PET-CT in selective nodal irradiation. METHODS Based on literature data on sensitivity and specificity of E(B)US-NA in FDG-PET-CT-staged NSCLC, false negative (FN) rates for different constellations of CT, PET and E(B)US-NA were calculated. The algorithm was tested on consecutive patients with N2/N3 disease referred for radiotherapy in Leuven and Maastricht. RESULTS An algorithm determining when to include LN in the GTV is proposed, based on data from 5 meta-analyses. Adding E(B)US-NA to FDG-PET-CT decreases the FN-rate, but for PET-positive and E(B)US-negative LN, FN rates are still 14-16%. In Leuven 520 LN were analyzed, in Maastricht 364 LN; with E(B)US-NA a geographical miss was avoided in 2 (2/40=5%) and 1 (1/28=4%) patients, respectively. CONCLUSIONS E(B)US-NA in addition to FDG-PET-CT for mediastinal staging decreases the risk of a geographical miss with 4-5%. The impact of this small decrease on survival is unknown. The proposed algorithm may guide the radiation oncologist when to include LN in the nodal GTV.
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Affiliation(s)
| | - Christophe Dooms
- Respiratory Oncology (Pneumology), University Hospitals Leuven/KU Leuven, Belgium
| | - Angela Van Baardwijk
- Radiation Oncology (MAASTRO Clinic), GROW, Maastricht University Medical Center, The Netherlands
| | | | | | - Johan Vansteenkiste
- Respiratory Oncology (Pneumology), University Hospitals Leuven/KU Leuven, Belgium
| | - Herbert Decaluwé
- Thoracic Surgery, University Hospitals Leuven/KU Leuven, Belgium
| | - Paul De Leyn
- Thoracic Surgery, University Hospitals Leuven/KU Leuven, Belgium
| | - Jonas Yserbyt
- Respiratory Oncology (Pneumology), University Hospitals Leuven/KU Leuven, Belgium
| | - Kristiaan Nackaerts
- Respiratory Oncology (Pneumology), University Hospitals Leuven/KU Leuven, Belgium
| | | | | | - Dirk De Ruysscher
- Radiation Oncology, University Hospitals Leuven/KU Leuven, Belgium; Radiation Oncology (MAASTRO Clinic), GROW, Maastricht University Medical Center, The Netherlands.
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Argento AC, Puchalski J. Convex probe EBUS for centrally located parenchymal lesions without a bronchus sign. Respir Med 2016; 116:55-8. [PMID: 27296821 DOI: 10.1016/j.rmed.2016.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/10/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Convex probe endobronchial ultrasound (CP-EBUS) has proven safe and accurate for identifying malignancy and granulomatous disease affecting the mediastinum and hilum. For the diagnosis of parenchymal lung lesions, conventional techniques such as transbronchial biopsy, brush and lavage are useful, particularly when an airway leads directly to the lesion. For centrally located intraparenchymal lesions, CP-EBUS has been shown to be efficacious. OBJECTIVE To expand on the existing literature in an effort to highlight the important diagnostic role of CP-EBUS in centrally located lesions, particularly those without a bronchus sign. METHODS In our cohort of 430 patients undergoing CP-EBUS between 03/2009-03/2012, we retrospectively identified 32 who underwent transbronchial needle aspiration (TBNA) of a centrally located parenchymal lung lesion. All lesions were completely surrounded by lung parenchyma and not visualized during white light bronchoscopy. Diagnostic yield was determined and compared to conventional bronchoscopic biopsy techniques, when performed. RESULTS The mean lesion size was 25.6 mm and 24/32 (75%) lesions were located in the lower lobes. A definitive diagnosis was obtained in 27/32 (84.4%) of parenchymal lesions without a bronchus sign biopsied using CP-EBUS. CP-EBUS provided the exclusive method of diagnosis in 15/32 (46.9%) patients in this cohort. Most lesions (26/32) were diagnosed as non-small cell carcinoma. There were no procedural complications. CONCLUSION CP-EBUS is useful for diagnosing parenchymal lung abnormalities without a bronchus sign, extending its scope beyond mediastinal and hilar lymph nodes. It is imperative that physicians performing EBUS maintain this tool as a complement to conventional bronchoscopic techniques.
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Affiliation(s)
- A Christine Argento
- Northwestern University, Interventional Pulmonology, Division of Pulmonary, Allergy and Critical Care Medicine, USA.
| | - Jonathan Puchalski
- Yale University, Interventional Pulmonology, Division of Pulmonary, Critical Care and Sleep Medicine, USA
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Mallya V, Kumar SP, Meganathan P, Shivkumar S, Mehta R. The utility of ROSE (rapid on-site evaluation) in endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA): Is the picture rosy? J Cytol 2016; 32:230-3. [PMID: 26811569 PMCID: PMC4707783 DOI: 10.4103/0970-9371.171226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mediastinal lymphadenopathy (ML) presents a diagnostic challenge. The technique to sample the lymph nodes has evolved from conventional "blind" transbronchial needle aspiration (TBNA) to the present day endobronchial ultrasound (EBUS)-guided procedure that improves the accuracy of sampling. OBJECTIVE This study was undertaken to evaluate the utility of "rapid on-site evaluation" (ROSE) in EBUS-guided TBNA (EBUS-TBNA) for the diagnosis of ML. PATIENTS AND METHODS This prospective study included 80 patients who underwent EBUS-TBNA for computed tomography/positron emission tomography (CT/PET) diagnosed ML over a 4-month period at a single tertiary care center. All 80 of these patients underwent histopathological evaluation (HPE) in addition to cytology. Three out of these 80 (3.7%) patients were excluded in view of inadequate material on EBUS-TBNA. After the sampling of nodes was done, the slides were stained with rapid hematoxylin and eosin (H&E) and then on-site evaluation was done. The tissue derived was also processed for HPE in all cases. RESULTS ROSE revealed granuloma in 27 patients and malignancy in 14 patients, and the remaining patients showed nonspecific inflammation. Concomitant histopathology revealed granuloma in 34 patients and malignancy in 14 patients. Considering HPE as gold standard, the overall sensitivity and specificity of EBUS-TBNA for diagnosis were 85.4% and 89.6%, respectively. For malignancy alone, the sensitivity and specificity were 100% and 98.4%, respectively. CONCLUSION This novel approach is safe, has good diagnostic yield, and has an excellent potential in assisting safe and accurate diagnostic interventional bronchoscope.
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Affiliation(s)
- Varuna Mallya
- Department of Pathology, Dr. BR Ambedkar Medical College, Bengaluru, Karnataka, India
| | - Sandeep P Kumar
- Department of Pathology, Dr. BR Ambedkar Medical College, Bengaluru, Karnataka, India
| | - Prabhu Meganathan
- Department of Pathology, Apollo Hospital, Bengaluru, Karnataka, India
| | - Swarna Shivkumar
- Department of Pathology, Apollo Hospital, Bengaluru, Karnataka, India
| | - Ravindra Mehta
- Department of Pulmonology, Apollo Hospital, Bengaluru, Karnataka, India
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Chen CH, Cheng WC, Wu BR, Chen CY, Chen WC, Hsia TC, Liao WC, Tu CY, Shih CM, Hsu WH, Wang KP. Improved diagnostic yield of bronchoscopy in peripheral pulmonary lesions: combination of radial probe endobronchial ultrasound and rapid on-site evaluation. J Thorac Dis 2016; 7:S418-25. [PMID: 26807290 DOI: 10.3978/j.issn.2072-1439.2015.12.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) of cytologic specimens is a useful ancillary technique in needle aspiration procedures of pulmonary/mediastinal lesions, but few reports had been carried out to confirm the utility in the diagnosis of peripheral pulmonary lesions (PPLs) by radial probe endobronchial ultrasound (R-EBUS). METHODS To evaluate the impact of ROSE on the diagnostic yield of R-EBUS for PPLs, we retrospectively analyzed the diagnostic yields of transbronchial biopsy (TBB) or brushing using R-EBUS for patients with PPLs in a tertiary university hospital from December 2012 to December 2014. RESULTS A total of 815 patients with PPLs were included. A definite diagnosis was made by R-EBUS-guided TBB or brushing for 627 patients (76.9%). A total of 279 patients (34.2%) were examined by a ROSE technique. The combination of R-EBUS guided TBB or brushing with ROSE raised the diagnostic yield in the diagnosis of PPLs, especially difficult cases: right apical and left apical-posterior segment locations, small PPLs <3 cm without bronchus signs on computed tomography (CT) scan, PPLs with pleural effusions, and the position of probe is not within. CONCLUSIONS ROSE can improve the PPLs diagnostic yield when using R-EBUS guided TBB or brushing.
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Affiliation(s)
- Chia-Hung Chen
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wen-Chien Cheng
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Biing-Ru Wu
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Chih-Yu Chen
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wei-Chun Chen
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Te-Chun Hsia
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wei-Chih Liao
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Chih-Yen Tu
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Chuen-Ming Shih
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Wu-Huei Hsu
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Ko-Pen Wang
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; 2 Department of Respiratory Therapy, 3 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan ; 4 School of Medicine, China Medical University, Taichung, Taiwan ; 5 Department of Internal Medicine, Hyperbaric oxygen therapy center, China Medical University, Taichung, Taiwan ; 6 Department of Life Science, National Chung Hsing University, Taichung, Taiwan ; 7 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
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Jiang JH, Turner JF, Huang JA. Endobronchial ultrasound elastography: a new method in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2016; 7:S272-8. [PMID: 26807274 DOI: 10.3978/j.issn.2072-1439.2015.12.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND TBNA through the flexible bronchoscope is a 37-year-old technology that utilizes a TBNA needle to puncture the bronchial wall and obtain specimens of peribronchial and mediastinal lesions through the flexible bronchoscope for the diagnosis of benign and malignant diseases in the mediastinum and lung. METHODS Since 2002, the Olympus Company developed the first generation ultrasound equipment for use in the airway, initially utilizing an ultrasound probe introduced through the working channel followed by incoroporation of a fixed linear ultrasound array at the distal tip of the bronchoscope. This new bronchoscope equipped with a convex type ultrasound probe on the tip was subsequently introduced into clinical practice. The convex probe (CP)-EBUS allows real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar lymph nodes. EBUS-TBNA is a minimally invasive procedure performed under local anesthesia that has been shown to have a high sensitivity and diagnostic yield for lymph node staging of lung cancer. RESULTS In 10 years of EBUS development, the Olympus Company developed the second generation EBUS bronchoscope (BF-UC260FW) with the ultrasound image processor (EU-M1), and in 2013 introduced a new ultrasound image processor (EU-M2) into clinical practice. FUJI company has also developed a curvilinear array endobronchial ultrasound bronchoscope (EB-530 US) that makes it easier for the operator to master the operation of the ultrasonic bronchoscope. Also, the new thin convex probe endobronchial ultrasound bronchoscope (TCP-EBUS) is able to visualize one to three bifurcations distal to the current CP-EBUS. CONCLUSIONS The emergence of EBUS-TBNA has also been accompanied by innovation in EBUS instruments. EBUS elastography is, then, a new technique for describing the compliance of structures during EBUS, which may be of use in the determination of metastasis to the mediastinal and hilar lymph nodes. This article describes these new EBUS techniques and reviews the relevant literature.
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Affiliation(s)
- Jun-Hong Jiang
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China, 2 Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - J Francis Turner
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China, 2 Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Jian-An Huang
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China, 2 Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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Chavez C, Sasada S, Izumo T, Watanabe J, Katsurada M, Matsumoto Y, Tsuchida T. Endobronchial ultrasound with a guide sheath for small malignant pulmonary nodules: a retrospective comparison between central and peripheral locations. J Thorac Dis 2015; 7:596-602. [PMID: 25973225 DOI: 10.3978/j.issn.2072-1439.2015.03.04] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/28/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Radial endobronchial ultrasound with a guide sheath (EBUS-GS) has improved the diagnostic accuracy of transbronchial biopsy (TBB) for malignant peripheral pulmonary nodules (PPNs). Many underscore the importance of tumor localization but reproducible results on other aspects that affect yield are few. We aimed to analyze the diagnostic performance of TBB with EBUS-GS and to know what group of patients can benefit most. METHODS The database of patients with malignant PPNs (≤30 mm) who underwent EBUS-GS TBB at the National Cancer Center Hospital, Tokyo, Japan from April 2012 to March 2013 was retrospectively reviewed and analysed based on lesion and procedural characteristics. RESULTS Most PPNs (N=212) were adenocarcinoma, measuring 20 mm [mean, standard deviation (SD) 5.45]. Overall diagnostic accuracy was 67.5% (143 of 212 cases). Factors that significantly affected and predicted diagnostic success were EBUS probe within (P=0.001) and parenchymal location that was not adjacent to the costal visceral pleura (P=0.001). When combined, these variables achieved an 87% (59 of 68 lesions) diagnostic yield. CT scan characteristic, lesion size, lobe location, and GS size were non-contributory. CONCLUSIONS EBUS-GS TBB is an acceptable diagnostic method for small peripheral lung cancer. It can be maximized for PPNs that are away from the pleura and when the EBUS probe can be placed within the lesion.
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Affiliation(s)
- Christine Chavez
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Shinji Sasada
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Takehiro Izumo
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Junko Watanabe
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Masahiro Katsurada
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Yuji Matsumoto
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
| | - Takaaki Tsuchida
- 1 Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan ; 2 Department of Internal Medicine, Division of Pulmonary Medicine, Kameda General Hospital, Chiba 296-8602, Japan
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Geake J, Hammerschlag G, Nguyen P, Wallbridge P, Jenkin GA, Korman TM, Jennings B, Johnson DF, Irving LB, Farmer M, Steinfort DP. Utility of EBUS-TBNA for diagnosis of mediastinal tuberculous lymphadenitis: a multicentre Australian experience. J Thorac Dis 2015; 7:439-48. [PMID: 25922723 PMCID: PMC4387413 DOI: 10.3978/j.issn.2072-1439.2015.01.33] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/17/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. There is limited data describing the accuracy & safety of this technique for the diagnosis of tuberculous mediastinal lymphadenitis. METHODS A multi-centre retrospective study of all EBUS-guided TBNA procedures that referred samples for mycobacteriology was performed. Results were correlated with post-procedural diagnoses after a period of surveillance and cross-checked against relevant statewide tuberculosis (TB) registries, and sensitivity and specificity was calculated. In addition, nucleic acid amplification techniques (NAAT) were assessed, and sensitivity and specificity calculated using positive mycobacterial culture as the reference gold standard. RESULTS One hundred and fifty-nine patients underwent EBUS-TBNA and had tissue referred for mycobacterial culture, of which 158 were included in the final analysis. Thirty-nine were ultimately diagnosed with TB (25%). Sensitivity of EBUS-TBNA for microbiologically confirmed tuberculous mediastinal lymphadenitis was 62% (24/39 cases). Specificity was 100%. Negative predictive value (NPV) and diagnostic accuracy for microbiologic diagnosis was 89% [95% confidence intervals (CI), 82-93%] and 91% (95% CI, 84-94%) respectively. For a composite clinicopathologic diagnosis of TB NPV and accuracy were 98% (95% CI, 93-99%) and 98% (95% CI, 95-99%) respectively. Sensitivity for NAAT was 38% (95% CI, 18-65%). CONCLUSIONS EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis and demonstrates good sensitivity for a microbiologic diagnosis of isolated mediastinal lymphadenitis. When culture and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates excellent diagnostic accuracy and NPV for the diagnosis of mediastinal TB lymphadenitis. We suggest EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected.
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