Liberman, J. Sampails, A. Duranceu, V. Thiffault, R. Hadjeres, P. Endosonography mediastinal lymph node staging of lung cancer. Clementsen, B. Skov, P. Vilmann, M. Endobronchial ultrasound-guided biopsy performed under optimal conditions in patients with known or suspected lung cancer may render mediastinoscopy unnecessary. J Bronchol Interven Pulmonol, 21 , pp.
- Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).
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Sanz-Santos, F. Andreo, E. Astudillo, et al. Representativeness of nodal sampling with endobronchial ultrasonography in non-small cell lung cancer staging. Ultrasound Med Biol, 38 , pp. Jernlas, H. Nyberger, L. Ek, R.
Diagnostic yield and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal lymphadenopathy. Clin Respir J, 6 , pp. Muguruza Trueba, J. Belda Sanchis, L.
Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA)
Yasufuku, A. Pierre, G. Darling, M. Waddell, M. Johnston, et al. A prospective controlled trial of endobronchial ultrasound guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal nodal staging of lung cancer. J Thorac Cardiovascular Surg, , pp. Um, H. Kim, S. Jung, J. Han, K.
Lee, H. Park, et al. Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging in non-small cel lung cancer. J Thorac Oncol, 10 , pp. Ong, H. Grosu, G. Eapen, M. Lazarus, D. Ost, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for systematical nodal staging in patients with N0 disease by computed tomography and integrated positron emission tomography—computed tomography.
Annals ATS, 3 , pp. Cerfolio, A. Bryant, B. Ojha, M. Ann Thorac Surg, 80 , pp. Talebian Yazdi, J. Egberts, M. Schinkelshoek, R. Wolterbeek, J. Nabers, B.
Venmans, et al. Endosonography for lung cancer staging: predictors of false negative results. Lung Cancer, 90 , pp. Subscribe to our newsletter. Mediastinitis After Endobronchial Ultrasound-Guided Instructions for authors Submit an article Ethics in publishing. Article options. Are you a health professional able to prescribe or dispense drugs? TBNA samples were categorized as: a diagnostic: if cTBNA enabled a final diagnosis of tuberculosis, sarcoidosis, malignancy, lymphoma and other diagnosis; b representative: either by a diagnostic sample or by a preponderance of benign lymphocytes.
Cytologic samples containing malignant cells were considered diagnostic of malignancy. A final diagnosis of sarcoidosis was made on the presence of all the following criteria: a consistent clinical and radiological presentation; b demonstration of non-necrotizing granulomas on c-TBNA along with negative acid-fast bacilli and fungal stains; and no growth of mycobacteria on MGIT; and, c clinical and radiological response after treatment with glucocorticoids.
A diagnosis of tuberculosis was based on the demonstration of all the following: a necrotizing granulomatous inflammation or presence of acid-fast bacilli AFB on microscopy or a positive culture for Mycobacterium tuberculosis ; and, b clinicoradiological response to anti-tuberculosis treatment. The yield of cTBNA technique was analyzed during the two periods with regards to representative sampling of lymph node and the diagnostic yield.
Statistical analysis was performed using the commercial statistical package StatsDirect Version 2. A total of 12, bronchoscopic procedures were carried out during the study period. Conventional TBNA was performed in 1, 8. There were The cTBNA was predominantly performed on lymph node stations 4R and 7 from to and almost exclusively in these stations thereafter.
The lymph node size data was available for patients lymph nodes.
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The median interquartile range size of lymph node station 4R and 7 was 20 A median of three passes were obtained from each lymph node station. The median interquartile range time needed for performing a cTBNA procedure was 15 13—20 minutes. A final diagnosis of sarcoidosis and tuberculosis was made in and 66 patients, respectively on the basis of results of pathological examination and microbiology while bronchogenic carcinoma was diagnosed in patients.
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Presumed sarcoidosis as an indication for performing cTBNA increased from Diagnosis and staging of bronchogenic carcinoma and other conditions as indications showed a decreasing trend from The size of the lymph nodes both station 4R and 7 and the time needed to perform the procedure were similar between the study periods. However, the median number of passes at station 4R was significantly higher in period I in comparison to period II.
Of the total number of bronchoscopic procedures, the proportion of cTBNA performed reduced from In two patients, the details of cytological examination were not available and hence they were excluded from the analysis for diagnostic yield. The results did not significantly differ even when the initial cases after introduction of EBUS were included in period II for the analysis of diagnostic yield Table 2. In the year wise analysis, there was a consistent increase in the diagnostic yield of cTBNA from The proportion of representative lymph node sampling as well as diagnostic yield has increased over time.
Bronchoscopy and endobronchial ultrasound for diagnosis and staging of lung cancer
The increase in diagnostic yield remained significant even after adjusting for the years of performing cTBNA and the type of anaesthesia topical anaesthesia vs. This was also seen in another study where the number of cTBNA procedures declined by almost half from This is due to the fact that conventional bronchoscopic techniques have a high diagnostic yield in patients with sarcoidosis. Although cTBNA is an easy and safe procedure to sample the mediastinal lymph nodes, it is underutilized due to the wide variations in the reported success rate and the unfounded fear of causing trauma to major blood vessels.
In a study comprising of patients with non-small cell lung carcinoma, there was significant increase in the diagnostic yield of cTBNA after EBUS training. Our study however, included an unselected group of patients comprising of both malignant and benign respiratory disorders. What are the clinical implications of this study? The results of the study do not imply that operators without EBUS misunderstand the mediastinal anatomy and are not correctly aspirating a lymph node station.
Endobronchial Ultrasound | PENTAX Medical (Global)
Rather, the fellows undergoing training perform cTBNA procedures better, due to superior understanding of the mediastinal anatomy after watching and training on EBUS. Finally, the study has a few limitations. This is a retrospective time-series analysis, a study design fraught with confounders and bias.