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Stirpe E, Bardaro F, Köhl J. Unusual lymphadenopathy diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Monaldi Arch Chest Dis 2022; 93. [PMID: 35608519 DOI: 10.4081/monaldi.2022.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 01/21/2023] Open
Abstract
Oxidized cellulose, used as hemostatic in thoracic surgery, may cause in some cases foreign body reactions, and simulate other diseases. We report the case of a 39-year-old man operated on a middle lobe lobectomy for atypical carcinoid. The follow up chest-CT showed enlarged mediastinal lymph nodes, so endobronchial ultrasound-guided transbronchial needle aspiration was performed suspecting recurrence of the tumor. The cytology results showed amorphous fragments such as foreign body reaction secondary to Pahacel®, used as hemostatic during the surgery. A few days later, the patient was re-operated on suspicion of mediastinitis induced by the endoscopic procedure. The aim of this case is to consider the foreign body reaction to Pahacel®, in patients with postoperative thoracic lymphadenopathy. It is also important to remember that in these patients the endoscopic procedures allow the diagnosis but may cause mediastinitis.
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Affiliation(s)
| | | | - Johanna Köhl
- Department of Respiratory Diseases, Bolzano Hospital.
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Kang N, Shin SH, Yoo H, Jhun BW, Lee K, Um SW, Kim H, Jeong BH. Infectious complications of EBUS-TBNA: A nested case-control study using 10-year registry data. Lung Cancer 2021; 161:1-8. [PMID: 34481209 DOI: 10.1016/j.lungcan.2021.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/02/2021] [Accepted: 08/26/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure, but little is known about its infectious complications. The aim of this study is to evaluate the incidence and risk factors of infectious complications of EBUS-TBNA and its clinical course, including effects on anti-cancer treatment. METHODS This is a nested case-control study of patients who received EBUS-TBNA and were followed for at least 2 months at Samsung Medical Center from August 2009 to April 2019. Patients with clinical symptoms of infection and correlating chest images were defined as the infection group (n = 33). The controls were randomly selected from patients without infectious complication. Multivariate logistic regression with backward selection was used to identify the risk factors of infectious complications. RESULTS Of the 6826 patients, 33 (0.48%) infectious complications were identified, comprising pneumonia (n = 20) and mediastinal infections (n = 13). Target lesions with necrotic features on chest computed tomography (CT) scan (adjusted odds ratio [aOR], 3.08; 95% confidence interval [CI], 1.49-6.40; P = 0.002) and procedures that were performed via the esophagus (aOR, 3.19; 95% CI, 1.47-6.88; P = 0.003) were independently associated with infectious complications. Among patients ultimately diagnosed with cancer, the infection group tended to refuse anti-cancer treatment compared to controls (32/459, 7.0% vs. 5/30, 16.7%; P = 0.066). However, among the patients who received anti-cancer treatment, there was no delay in onset of treatment. CONCLUSIONS Infectious complications of EBUS-TBNA are rare; however, attention should be paid if the target lesion appears necrotic on chest CT or if the procedure is performed via the esophagus. Although it was not conclusive due to its rarity, patients with infectious complications tended not to receive anti-cancer treatment.
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Affiliation(s)
- Noeul Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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The Incidence of Hemorrhagic Complications Was Lower With the Guide Sheath Than With the Conventional Forceps Biopsy Method: Results of Bronchoscopy in the 2016 Nationwide Survey by the Japan Society for Respiratory Endoscopy. J Bronchology Interv Pulmonol 2021; 27:253-258. [PMID: 32282445 PMCID: PMC7523573 DOI: 10.1097/lbr.0000000000000669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The Japan Society for Respiratory Endoscopy performed a nationwide survey to evaluate the current status and complications of bronchoscopy. Data on deaths due to bronchoscopy, complications after bronchoscopy, and particularly, complications of forceps biopsy were surveyed. Methods: The survey form was mailed to 532 facilities accredited by the society. The numbers of procedures, complications, and deaths were investigated. Results: The response rate was 79.1% (421 facilities). Deaths attributable to diagnostic bronchoscopy occurred in 11 (0.011%) of 98,497 cases. In regards to forceps biopsy, the guide sheath method was applied in 23,916 cases and the conventional method in 31,419 cases was done with conventional method. Complications of forceps biopsy developed in 1019 cases in total, with an incidence rate of 1.84%. The most frequent complication was pneumothorax (0.70%), followed by pneumonia/pleurisy (0.46%) and hemorrhage (0.45%). The incidence of hemorrhagic complication was significantly lower in the guide sheath group than in the non-guide sheath group (0.29% vs. 0.58%; P<0.001). The overall incidence of complications (1.63% vs. 2.00%; P=0.002) and the mortality rate (0% vs. 0.02%; P=0.04) were significantly lower in the guide sheath group. Conclusion: The incidence of hemorrhagic complications in forceps biopsy of peripheral pulmonary lesions was lower when the guide sheath method was applied. It is necessary to increase the awareness for safety control in diagnostic bronchoscopy for new procedures.
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Jang JG, Ahn JH, Lee SS. Delayed onset of mediastinitis with tracheomediastinal fistula following endobronchial ultrasound-guided transbronchial needle aspiration; A case report. Thorac Cancer 2021; 12:1134-1136. [PMID: 33605045 PMCID: PMC8017241 DOI: 10.1111/1759-7714.13888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/12/2022] Open
Abstract
Infectious complications after endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) are rare but serious. Here, we report a very rare case of delayed onset of mediastinitis with tracheomediastinal fistula after EBUS‐TBNA. Surgical debridement was performed, antibiotics were administered, and the postoperative course of the patient was good. Careful monitoring is needed to prevent the possible development of infectious complications after EBUS‐TBNA.
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Affiliation(s)
- Jong Geol Jang
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea
| | - June Hong Ahn
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea
| | - Seok Soo Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University and Yeungnam University Medical Center, Daegu, South Korea
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Clinical Characteristics of and Risk Factors for Fever after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Retrospective Study Involving 6336 Patients. J Clin Med 2020; 9:jcm9010152. [PMID: 31935941 PMCID: PMC7019550 DOI: 10.3390/jcm9010152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 02/03/2023] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic for mediastinal and hilar lymphadenopathy/mass. This study investigated fever incidence and associated risk factors after EBUS-TBNA in 6336 patients who underwent EBUS-TBNA at Asan Medical Center from October 2008 to February 2018. Bronchoscopists evaluated participants’ medical records for fever the 24 h following EBUS-TBNA. Patients were placed in either a Fever group (n = 665) or a non-Fever group (n = 5671). Fever developed in 665 of 6336 patients (10.5%) with a mean peak body temperature of 38.3 °C (range, 37.8–40.6 °C). Multivariate analysis revealed that fever-associated risk factors after EBUS-TBNA are older age (adjusted OR 0.015, 95% CI (0.969–0.997), p = 0.015), bronchoscopic washing (adjusted OR 1.624, 95% CI (1.114–2.368), p = 0.012), more than four samples of EBUS-TBNA (adjusted OR 2.472, 95% CI (1.288–4.745), p = 0.007), hemoglobin levels before EBUS-TBNA (adjusted OR 0.876, 95% CI (0.822–0.933), p < 0.001), CRP levels before EBUS-TBNA (adjusted OR 1.115, 95% CI (1.075–1.157), p < 0.001), and a diagnosis of EBUS-TBNA tuberculosis (adjusted OR 3.409, 95% CI (1.870–6.217), p < 0.001). Clinicians should be aware of the possibility of fever after EBUS-TBNA because it is common. Additional, prospective, large-scale research should assess the need for prophylactic antibiotics for EBUS-TBNA.
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Cocciardi S, Borah A, Terrigno R, Abouzgheib W, Boujaoude Z. A case report of an expensive yet necessary thoracentesis: Expanding the boundaries of endoscopic ultrasound transbronchial needle aspiration. Medicine (Baltimore) 2019; 98:e17555. [PMID: 31593139 PMCID: PMC6799771 DOI: 10.1097/md.0000000000017555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS). PATIENT CONCERNS 52-year-old women with dyspnea, fever and a new loculated pleural effusion that was suspected to be the source of the fever but was not accessible through traditional thoracentesis. DIAGNOSIS Malignant pleural effusion. INTERVENTIONS Sampling and drainage of the loculated pleural fluid collection using EBUS scope introduced via the esophagus. OUTCOMES Infection excluded. Resolution of fever and improved dyspnea after drainage of effusion. LESSONS The convex curvilinear ultrasound bronchoscope allows unprecedented access to thoracic structures. The reach is not limited to mediastinal lymph nodes and parenchymal masses adjacent to the airways, and pleural space and pleural fluid are at times accessible, particularly when one considers the esophageal approach.
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Kurokawa K, Asao T, Ko R, Nagaoka T, Suzuki K, Takahashi K. Severe mediastinitis over a month after endobronchial ultrasound-guided transbronchial needle aspiration. Respirol Case Rep 2019; 7:e00426. [PMID: 31007930 PMCID: PMC6454807 DOI: 10.1002/rcr2.426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/26/2022] Open
Abstract
Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to be a minimally invasive and relatively safe procedure, mediastinitis is a serious complication related to the procedure. The median time of mediastinitis onset is approximately 12 days after EBUS-TBNA. Here we report two rare cases with mediastinitis onset 40 and 53 days after EBUS-TBNA. Surgical drainage was performed since systemic treatment with antibiotics was insufficient in both cases. Eikenella corrodens, which is a slow-growing microorganism, was identified as the causative pathogen in one case. To our knowledge, this is the first report of mediastinitis occurring over a month after EBUS-TBNA. Clinicians should consider the diagnosis of mediastinitis even if symptoms appear over a month after EBUS-TBNA.
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Affiliation(s)
- Kana Kurokawa
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Tetsuhiko Asao
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Ryo Ko
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Tetsutaro Nagaoka
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Kenji Suzuki
- Department of General Thoracic SurgeryJuntendo University School of MedicineTokyoJapan
| | - Kazuhisa Takahashi
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
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Zaman MK, Shrestha R. Major Complications Associated with Conventional Transbronchial Needle Aspiration. South Med J 2019; 111:565-571. [PMID: 30180255 DOI: 10.14423/smj.0000000000000857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Transbronchial needle aspiration (TBNA) is a widely used sampling technique for diagnosis and staging of lesions centered around bronchoscopically accessible airways. We report our single-institution experience of complications associated with conventional TBNA (C-TBNA) performed in 606 consecutive cases. METHODS Electronic medical records with bronchoscopy log data of C-TBNAs performed from January 2003 to December 2016 were assessed. All of the cases were included for a review of complications related to the performance of C-TBNA. C-TBNAs were performed in conjunction with other bronchoscopic sampling techniques such as brush, biopsy, and wash in most cases. Complications ascribed to C-TBNA only were included for this analysis and review. RESULTS Infectious complications following the performance of TBNA are related to the inoculation of oropharyngeal bacteria from the airway lumen into the sterile mediastinal, pericardial, or pleural space. CONCLUSIONS Complications related to TBNA are underappreciated mainly because of the lack of reporting and awareness. These findings should lead to heightened awareness and precaution in all patients undergoing TBNA, and extra vigilance and monitoring during and after the procedure in those receiving anticoagulant and antiplatelet therapies.
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Affiliation(s)
- Muhammad K Zaman
- From the Department of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, and the Veterans Affairs Medical Center, Memphis, Tennessee
| | - Rabin Shrestha
- From the Department of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, and the Veterans Affairs Medical Center, Memphis, Tennessee
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Shimada S, Furusawa H, Ishikawa T, Kamakura E, Suzuki T, Watanabe Y, Fujiwara T, Tominaga S, Komatsuzaki KM, Natsume I. Development of mediastinal adenitis six weeks after endobronchial ultrasound-guided transbronchial needle aspiration. Respir Med Case Rep 2018; 25:161-164. [PMID: 30175038 PMCID: PMC6115609 DOI: 10.1016/j.rmcr.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022] Open
Abstract
A 60-year-old man visited our hospital for further examination of an abnormal chest radiograph. Computed tomography (CT) images revealed enlarged mediastinal lymph nodes and multiple pulmonary nodules. Further evaluation by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed and he was diagnosed with sarcoidosis. Six weeks after EBUS-TBNA, he presented to the emergency department with a high-grade fever. CT scan revealed an enlarged mediastinal lymph node. He was diagnosed with mediastinal adenitis and treated successfully with antibiotics. EBUS-TBNA is a highly accurate diagnostic tool, but clinicians should be aware of mediastinal infectious complication that could be asymptomatic for long period of time.
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Affiliation(s)
- Sho Shimada
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan.,Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Haruhiko Furusawa
- Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Toshihisa Ishikawa
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Eisaku Kamakura
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Takafumi Suzuki
- Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yuta Watanabe
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Takasato Fujiwara
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Shinichiro Tominaga
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Keiko Mitaka Komatsuzaki
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Ichiro Natsume
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
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Wahidi MM, Ernst A. Point: Should UItrasonographic Endoscopy Be the Preferred Modality for Staging of Lung Cancer? Yes. Chest 2018; 145:447-449. [PMID: 27845631 DOI: 10.1378/chest.13-2722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Momen M Wahidi
- Division of Pulmonary and Critical Care Medicine and Department of Medicine, Duke University Medical Center Durham, NC.
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Mediastinitis Following Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. J Bronchology Interv Pulmonol 2018; 24:323-329. [PMID: 28195963 DOI: 10.1097/lbr.0000000000000370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mediastinitis is a rare complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Recent reports of infectious complications following EBUS-TBNA involved oropharyngeal bacteria. Here, we report 2 unusual cases of post-EBUS-TBNA mediastinitis involving Streptococcus pneumoniae and Pseudomonas aeruginosa, which were likely the result of direct inoculation of the organisms at the time of transbronchial needle aspiration. The first case was successfully treated with computed tomography-guided drainage and antibiotics, whereas the second case had >50% distal tracheal obstruction and near total occlusion of the left main stem bronchus, requiring rigid bronchoscopy, stent placement, debulking, and antibiotics. Review of literature suggests that the isolated pathogens are rare in this setting and are most likely not related to oropharyngeal contamination during bronchoscope insertion. Active bronchitis should be considered an additional risk factor for EBUS-TBNA-induced mediastinitis. We suggest possible methods to decrease the risk of this serious postprocedure complication. It is important to be vigilant about the possibility of mediastinitis in patients that undergo EBUS-TBNA. Fever and respiratory symptoms should lower the threshold for ordering a computed tomography chest for early detection and management. Our patients did not require thoracic surgery for the management of the mediastinitis.
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Lentz RJ, Maldonado F. Acute exacerbations of interstitial lung disease: Don't just do something, stand there! Respirology 2018; 22:215-216. [PMID: 28102969 DOI: 10.1111/resp.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Aljohaney AA. Utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration in patients with mediastinal and hilar lymphadenopathy: Western region experience. Ann Thorac Med 2018; 13:92-100. [PMID: 29675060 PMCID: PMC5892095 DOI: 10.4103/atm.atm_317_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS The aim of the study was to evaluate the clinical utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal and hilar lymphadenopathy and to explicitly describe the utility of this procedure in patient's outcome. METHODS A retrospective review and analysis was conducted on 52 patients with mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA from June 2012 to June 2016. All the patients were evaluated by computed tomography (CT) chest with contrast before EBUS examination. Enlarged mediastinal or hilar lymph node was defined as >1 cm short axis on the enhanced CT. RESULTS Among the 52 patients studied, 57.7% were presented with mediastinal or hilar lymphadenopathy for diagnosis and 42.3% presented with suspected mediastinal malignancy. Paratracheal stations were the most common site for puncture in 33 lymph nodes (43%). The best diagnostic yield was obtained from subcarinal stations and the lowest yield from the hilar stations. Surgical biopsies confirmed lymphoma in six patients, tuberculosis (TB) in three, sarcoidosis in two and one had metastatic adenocarcinoma of unknown primary. The sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA for diagnosis of mediastinal and hilar lymph node abnormalities were 78.6%, 100%, 100%, and 80%, respectively. The diagnostic yield of EBUS-TBNA in malignant and benign conditions was 79.0%. CONCLUSIONS EBUS-TBNA is a safe and efficacious procedure which can be performed using conscious sedation with high yields. It can be used for the staging of malignancies as well as for the diagnosis of inflammatory and infectious conditions such as sarcoidosis and TB.
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Affiliation(s)
- Ahmed A Aljohaney
- Department of Internal Medicine, Faculty of Medicine, King Abdul Aziz University, Jeddah, Saudi Arabia
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15
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Yokoyama Y, Nakagomi T, Shikata D, Higuchi R, Oyama T, Goto T. Surgical treatment for mediastinal abscess induced by endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review. World J Surg Oncol 2017; 15:130. [PMID: 28709438 PMCID: PMC5513248 DOI: 10.1186/s12957-017-1206-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/08/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful and less invasive procedure for the definitive diagnosis of mediastinal and hilar lymph nodes. However, infectious complications can occur after EBUS-TBNA, although they are extremely rare. CASE PRESENTATION A 66-year-old man with necrotic and swollen lower paratracheal lymph nodes underwent EBUS-TBNA. A mediastinal abscess developed 9 days post-procedure. Surgical drainage and debridement of the abscess were performed along with lymph node biopsy followed by daily washing of the thoracic cavity. Surgical treatment was effective, leading to remission of the abscess. Biopsy revealed that the tumor was squamous cell carcinoma with no radiologically detected cancer elsewhere in the body. Mediastinal lung cancer was thus confirmed. Subsequent chemoradiotherapy led to the remission of the tumor. CONCLUSIONS Mediastinitis after EBUS-TBNA is rare but should be considered, particularly if the target lymph nodes are necrotic. Mediastinitis can lead to serious and rapid deterioration of the patient's condition, for which surgical intervention is the treatment of choice.
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Affiliation(s)
- Yujiro Yokoyama
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan
| | - Takahiro Nakagomi
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan
| | - Daichi Shikata
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan
| | - Rumi Higuchi
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan
| | - Toshio Oyama
- Department of Pathology, Yamanashi Central Hospital, Yamanashi, Japan
| | - Taichiro Goto
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan.
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Vaidya PJ, Munavvar M, Leuppi JD, Mehta AC, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration: Safe as it sounds. Respirology 2017. [DOI: 10.1111/resp.13094] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Preyas J. Vaidya
- Institute of Pulmonology, Medical Research and Development; Mumbai India
- Department of Pulmonary Medicine, Fortis Hospitals; Mumbai India
| | - Mohammed Munavvar
- Department of Pulmonary Medicine, Lancashire Teaching Hospitals; Preston UK
| | - Joerg D. Leuppi
- Department of Internal Medicine, Kantonsspital Baselland, Liestal; Basel Switzerland
| | - Atul C. Mehta
- Department of Pulmonary Medicine, Cleveland Clinic; Cleveland Ohio USA
| | - Prashant N. Chhajed
- Institute of Pulmonology, Medical Research and Development; Mumbai India
- Department of Pulmonary Medicine, Fortis Hospitals; Mumbai India
- Department of Internal Medicine, Kantonsspital Baselland, Liestal; Basel Switzerland
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Severe Mediastinitis and Pericarditis After Transbronchial Needle Aspiration. Ann Thorac Surg 2016; 100:1881-3. [PMID: 26522531 DOI: 10.1016/j.athoracsur.2014.12.093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/08/2014] [Accepted: 12/16/2014] [Indexed: 12/12/2022]
Abstract
Endobronchial ultrasonographically guided transbronchial needle aspiration (EBUS-TBNA) is now widely performed for mediastinal lymph node staging of lung cancer. Although this procedure is less invasive than mediastinoscopy, some infectious complications have been reported. We report the successful use of pericardial and mediastinal drainage in a case of acute severe mediastinitis with pericarditis after EBUS-TBNA.
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Leong S, Shaipanich T, Lam S, Yasufuku K. Diagnostic bronchoscopy--current and future perspectives. J Thorac Dis 2014; 5 Suppl 5:S498-510. [PMID: 24163743 DOI: 10.3978/j.issn.2072-1439.2013.09.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/11/2013] [Indexed: 12/25/2022]
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide. Standard bronchoscopy has limited ability to accurately localise and biopsy pulmonary lesions that cannot be directly visualised. The field of advanced diagnostic bronchoscopy is rapidly evolving due to advances in electronics and miniaturisation. Bronchoscopes with smaller outer working diameters, coupled with miniature radial and convex ultrasound probes, allow accurate central and peripheral pulmonary lesion localisation and biopsy while at the same time avoiding vascular structures. Increases in computational processing power allow three-dimensional reconstruction of computed tomographic raw data to enable virtual bronchoscopy (VB), providing the bronchoscopist with a preview of the bronchoscopy prior to the procedure. Navigational bronchoscopy enables targeting of peripheral pulmonary lesions (PPLs) via a "roadmap", similar to in-car global positioning systems. Analysis of lesions on a cellular level is now possible with techniques such as optical coherence tomography (OCT) and confocal microscopy (CM). All these tools will hopefully allow earlier and safer lung cancer diagnosis and in turn better patient outcomes. This article describes these new bronchoscopic techniques and reviews the relevant literature.
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Affiliation(s)
- Steven Leong
- Department of Thoracic Medicine, University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Queensland, Australia 4032
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Onuki T, Kuramochi M, Inagaki M. Mediastinitis of bronchogenic cyst caused by endobronchial ultrasound-guided transbronchial needle aspiration. Respirol Case Rep 2014; 2:73-5. [PMID: 25473572 PMCID: PMC4184511 DOI: 10.1002/rcr2.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/04/2014] [Indexed: 12/31/2022] Open
Abstract
Here, we describe the case of a 56-year-old female patient who was diagnosed with an anterior mediastinal cyst measuring 26 × 16 mm in size. An endobronchial ultrasound-guided transbronchial needle aspiration was performed, and punctures occurred three times. The patient was then prescribed cefditoren pivoxil. Three days after the procedure, the patient developed infective mediastinitis. Panipenem/betamipron, clindamycin, and human immunoglobulin were administered, and her symptoms improved over 2 weeks. Five months after developing mediastinitis, surgical resection of the cyst was performed with inverted L-shaped mini-sternotomy. The cystic lesion strongly adhered to the surrounding tissues. The final pathological diagnosis was a bronchogenic cyst. Endobronchial ultrasound-guided transbronchial needle aspiration is not a completely sterile procedure and can lead to severe infective complications in the mediastinum. Although this procedure may not be contraindication for use with mediastinal cystic lesions, physicians must take into account the risk of severe infective complications.
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Affiliation(s)
- Takuya Onuki
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital Tsuchiura, Japan
| | - Masami Kuramochi
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital Tsuchiura, Japan
| | - Masaharu Inagaki
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital Tsuchiura, Japan
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Needle assembly malfunction: an unusual complication related to endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchology Interv Pulmonol 2013; 20:252-5. [PMID: 23857201 DOI: 10.1097/lbr.0b013e3182a14691] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration has become an invaluable tool for thoracic physicians. Along with medical complications, it is also important to understand the equipment-related malfunctions. The EBUS scope is delicate and requires dedicated needle assembly for performing the needle aspirates. EBUS scope damage could be expensive and has been well described. We report 2 rare cases of Olympus EBUS needle assembly malfunction (model NA-201SX-4021/4022). The first case describes needle breakage and the second case reports the separation of shaft of sheath-sliding mechanism.
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Mediastinal Abscess After Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. J Bronchology Interv Pulmonol 2013; 20:338-41. [DOI: 10.1097/lbr.0b013e31829ae243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Motas N, Motas C, Achim D, Horvat T. eComment. Fatal purulent mediastinitis after endobronchial ultrasound-guided transbronchial needle aspiration and mediastinoscopy. Interact Cardiovasc Thorac Surg 2013; 17:752-3. [PMID: 24065764 DOI: 10.1093/icvts/ivt342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Natalia Motas
- Clinic of Thoracic Surgery, Institute of Oncology, Bucharest, Romania
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Gochi F, Chen F, Aoyama A, Date H. Mediastinal infectious complication after endobronchial ultrasound-guided transbronchial needle aspiration. Interact Cardiovasc Thorac Surg 2013; 17:751-2. [PMID: 23814134 DOI: 10.1093/icvts/ivt273] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report here a mediastinal infectious complication after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) that was successfully treated using intravenous antibiotic therapy. EBUS-TBNA was performed for a 59-year old man with mediastinal adenopathy 8 years after left pneumonectomy for squamous cell carcinoma of the lung. A single-needle pass produced an adequate cytology and histology sample, and the lesion was diagnosed as small-cell lung cancer. The procedure itself was uneventful, but the patient developed a nightly fever after the biopsy. Finally, he was readmitted, and intravenous antibiotic therapy was required for 4 weeks to treat a mediastinal infection after EBUS-TBNA before chemotherapy for small-cell lung cancer.
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Affiliation(s)
- Fumiaki Gochi
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
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Hiraishi Y, Goto Y, Ohishi N, Nagase T. Infectious mediastinal lymphadenopathy after repeated transbronchial needle aspiration. BMJ Case Rep 2013; 2013:bcr-2012-007998. [PMID: 23723103 DOI: 10.1136/bcr-2012-007998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s was diagnosed with squamous cell carcinoma (cT1aN2M0) by repeated transbronchial needle aspirations (one conventional and one using endobronchial ultrasonography) of the subcarinal lymph node. Shortly after the initiation of chemoradiotherapy, he began to have chest pain with a high fever. CT showed only subcarinal lymph node swelling. Treatment with several antibiotics was started, and his fever decreased gradually. Chest CT showed shrinking of the subcarinal lymph node, and a diagnosis of infectious lymphadenopathy was made. Infectious lymphadenopathy can be difficult to diagnose because the symptoms are often non-specific and CT findings are not useful in differentiating tumour growth.
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Affiliation(s)
- Yoshihisa Hiraishi
- Department of Respiratory Medicine, The University of Tokyo, Tokyo, Japan
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Asano F, Aoe M, Ohsaki Y, Okada Y, Sasada S, Sato S, Suzuki E, Semba H, Fukuoka K, Fujino S, Ohmori K. Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res 2013; 14:50. [PMID: 23663438 PMCID: PMC3655828 DOI: 10.1186/1465-9921-14-50] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/07/2013] [Indexed: 12/12/2022] Open
Abstract
Background With the recent widespread use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), there have been occasional reports on complications associated with its use. Previous reviews on EBUS-TBNA have been limited to studies by skilled operators, thus the results may not always be applicable to recent clinical practice. To assess the safety of EBUS-TBNA for the staging and diagnosis of lung cancer in Japan, a nationwide survey on its current usage status and complications associated with its use was conducted by the Japan Society for Respiratory Endoscopy (JSRE). Methods A questionnaire about EBUS-TBNA performed between January 2011 and June 2012 was mailed to 520 JSRE-accredited facilities. Results Responses were obtained from 455 facilities (87.5%). During the study period, EBUS-TBNA was performed in 7,345 cases in 210 facilities (46.2%) using a convex probe ultrasound bronchoscope, for 6,836 mediastinal and hilar lesions and 275 lung parenchymal lesions. Ninety complications occurred in 32 facilities. The complication rate was 1.23% (95% confidence interval, 0.97%-1.48%), with hemorrhage being the most frequent complication (50 cases, 0.68%). Infectious complications developed in 14 cases (0.19%) (Mediastinitis, 7; pneumonia, 4; pericarditis, 1; cyst infection, 1; and sepsis, 1). Pneumothorax developed in 2 cases (0.03%), one of which required tube drainage. Regarding the outcome of the cases with complications, prolonged hospitalization was observed in 14 cases, life-threatening conditions in 4, and death in 1 (severe cerebral infarction) (mortality rate, 0.01%). Breakage of the ultrasound bronchoscope occurred in 98 cases (1.33%) in 67 facilities (31.9%), and that of the puncture needle in 15 cases (0.20%) in 8 facilities (3.8%). Conclusions Although the complication rate associated with EBUS-TBNA was found to be low, severe complications, including infectious complications, were observed, and the incidence of device breakage was high. Since the use of EBUS-TBNA is rapidly expanding in Japan, an educational program for its safe performance should be immediately established.
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Affiliation(s)
- Fumihiro Asano
- Safety Management Committee, Japan Society for Respiratory Endoscopy, Tokyo, Japan.
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Hong G, Song J, Lee KJ, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Um SW. Bronchogenic cyst rupture and pneumonia after endobronchial ultrasound-guided transbronchial needle aspiration: a case report. Tuberc Respir Dis (Seoul) 2013; 74:177-80. [PMID: 23678359 PMCID: PMC3651928 DOI: 10.4046/trd.2013.74.4.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 07/31/2012] [Accepted: 08/16/2012] [Indexed: 11/24/2022] Open
Abstract
We report a 54-year-old woman who presented with a well-defined, homogeneous, and non-enhancing mass in the retrobronchial region of the bronchus intermedius. The patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histological confirmation. Serous fluid was aspirated by EBUS-TBNA. Cytological examination identified an acellular smear with negative microbiological cultures. The patient was finally diagnosed with bronchogenic cysts by chest computed tomography (CT) and EBUS-TBNA findings. However, 1 week after EBUS-TBNA, the patient developed bronchogenic cyst rupture and pneumonia. Empirical antibiotics were administered, and pneumonia from the bronchogenic cyst rupture had resolved on follow-up chest CT. To our knowledge, this is the first reported case of pneumonia from bronchogenic cyst rupture after EBUS-TBNA.
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Affiliation(s)
- Goohyeon Hong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration is becoming the standard of care for mediastinal sampling to diagnose and stage lung cancer. It is considered to be safe and rivals the gold standard, mediastinoscopy, in safety and accuracy. The present article describes a mucosal airway laceration and pneumothorax associated with the procedure.
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Özgül MA, Çetinkaya E, Tutar N, Özgül G. An unusual complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): the needle breakage. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:567-9. [PMID: 23518624 DOI: 10.5761/atcs.cr.12.02015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is now becoming a widely accepted procedure to investigate the mediastinum for the staging of non-small-cell lung cancer and diagnosing mediastinal lesions. During the intervention, some minor or major complications may occasionally occur. The present case report describes the first reported case of needle breakage during EBUS-TBNA.
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Affiliation(s)
- M Akif Özgül
- Department of Pulmonary Medicine, Yedikule Chest Disease and Surgery Training and Research Hospital
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Yang H, Zhao H, Garfield DH, Teng J, Han B, Sun J. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of non-lymph node thoracic lesions. Ann Thorac Med 2013; 8:14-21. [PMID: 23439919 PMCID: PMC3573552 DOI: 10.4103/1817-1737.105714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/26/2012] [Indexed: 12/25/2022] Open
Abstract
AIMS: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has shown excellent diagnostic capabilities for mediastinal and hilar lymphadenopathy. However, its value in thoracic non-lymph node lesions is less clear. This study was designed to assess the value of EBUS-TBNA in distinguishing malignant from benign thoracic non-lymph node lesions. METHODS: From October 2009 to August 2011, 552 patients underwent EBUS-TBNA under local anesthesia and with conscious sedation. We retrospectively reviewed 81 of these patients who had tracheobronchial wall-adjacent intrapulmonary or isolated mediastinal non-lymph node lesions. On-site cytological evaluation was not used. Immunohistochemistry (IHC) was performed to distinguish the origin or type of malignancy when necessary. RESULTS: EBUS-TBNA was performed in 68 tracheobronchial wall-adjacent intrapulmonary and 13 isolated mediastinal non-lymph node lesions. Of the 81 patients, 77 (95.1%, 60 malignancies and 17 benignancies) were diagnosed through EBUS-TBNA, including 57 primary lung cancers, 2 mediastinal tumors, 1 pulmonary metastatic adenocarcinoma, 7 inflammation, 5 tuberculosis, 3 mediastinal cysts, 1 esophageal schwannoma, and 1 focal fibrosis. There were four false-negative cases (4.9%). Of the 60 malignancies, there were 9 (15.0%) which originally had no definite histologic origin or type. Thus, IHC was performed, with 7 (77.8%) being subsequently confirmed. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA in distinguishing malignant from benign lesions were 93.4% (60/64), 100% (17/17), 100% (60/60), 81.0% (17/21), and 95.1% (77/81), respectively. CONCLUSION: EBUS-TBNA is a safe procedure with a high sensitivity for distinguishing malignant from benign thoracic non-lymph node lesions within the reach of EBUS-TBNA, with IHC usually providing a more definitive diagnosis.
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Affiliation(s)
- Huizhen Yang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
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Dhillon SS, Dexter EU. Advances in bronchoscopy for lung cancer. J Carcinog 2012; 11:19. [PMID: 23346012 PMCID: PMC3548337 DOI: 10.4103/1477-3163.105337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 12/13/2012] [Indexed: 12/14/2022] Open
Abstract
Bronchoscopic techniques have seen significant advances in the last decade. The development and refinement of different types of endobronchial ultrasound and navigation systems have led to improved diagnostic yield and lung cancer staging capabilities. The complication rate of these minimally invasive procedures is extremely low as compared to traditional transthoracic needle biopsy and surgical sampling. These advances augment the safe array of methods utilized in the work up and management algorithms of lung cancer.
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Affiliation(s)
- Samjot Singh Dhillon
- Department of Medicine Pulmonary Medicine and Thoracic Oncology, Roswell Park Cancer Institute, New York, USA ; Department of Medicine, State University of New York at Buffalo, New York, USA
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Oguri T, Imai N, Imaizumi K, Elshazley M, Hashimoto I, Hashimoto N, Hasegawa Y. Febrile complications after endobronchial ultrasound-guided transbronchial needle aspiration for intra-pulmonary mass lesions of lung cancer--a series of 3 cases. Respir Investig 2012. [PMID: 23199981 DOI: 10.1016/j.resinv.2012.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent case reports have shown that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions is sometimes accompanied by severe infectious complications. Here, we report 3 cases with refractory febrile complications following EBUS-TBNA for intra-pulmonary large mass lesion of lung cancer (squamous cell carcinoma, n=2; adenocarcinoma, n=1). After the EBUS-TBNA, all cases showed prolonged fever and systemic inflammation despite receiving a sufficient dose of broad-spectrum antibiotics. The presence of a low-density area inside the masses upon CT examination, suggesting necrosis, may be a predictive sign of febrile complications associated with EBUS-TBNA.
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Affiliation(s)
- Tomoyo Oguri
- Department of Respiratory Medicine, Nagoya Graduate School of Medicine, Nagoya, Japan
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Borges N, Saha S. The value of mediastinoscopy in the management of thoracic disease. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Botana-Rial M, Núñez-Delgado M, Pallarés-Sanmartín A, Leiro-Fernández V, Represas Represas C, González Silva AI, Fernández-Villar A. Intramural Hematoma of the Pulmonary Artery and Hemopneumomediastinum after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Respiration 2012; 83:353-6. [DOI: 10.1159/000332925] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/31/2011] [Indexed: 11/19/2022] Open
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Colt HG, Davoudi M, Murgu S. Scientific evidence and principles for the use of endobronchial ultrasound and transbronchial needle aspiration. Expert Rev Med Devices 2011; 8:493-513. [PMID: 21728734 DOI: 10.1586/erd.11.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound (EBUS), using the radial EBUS probe and convex-probe EBUS-guided transbronchial needle aspiration, are increasingly advocated for a wide array of minimally invasive thoracic procedures. The effectiveness of EBUS-guided procedures has been demonstrated to a degree that, in many institutions, EBUS is becoming standard of practice for the diagnosis, staging and restaging of mediastinal lymphadenopathy in lung cancer, the diagnosis of sarcoidosis, and for bronchoscopic biopsy of peripheral lung lesions. Its role in other bronchoscopic procedures requires further study despite an already strong body of literature: diagnosis of lymphoma and benign infectious disease, diagnosis of early lung cancer and airway wall disorders, imaging of thoracic vascular disease such as pulmonary embolism, and therapeutic procedures such as placement of fiducial markers. In this article, we illustrate some of the principles of EBUS, describe major technical aspects pertaining to the procedure itself and provide a narrative review of original research addressing proposed roles of EBUS in a variety of indications. In closing, we describe future perspectives including new educational processes and philosophies that could favorably impact the rapid and safe dissemination of this evolving technology into clinical practice.
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Affiliation(s)
- Henri G Colt
- Pulmonary and Critical Care Medicine, University of California-Irvine, 101 The City Drive S., Orange, CA 92868, USA.
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Nakajima J. Invited commentary. Ann Thorac Surg 2011; 91:836. [PMID: 21353008 DOI: 10.1016/j.athoracsur.2011.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 01/11/2011] [Accepted: 01/17/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Jun Nakajima
- Department of Cardiothoracic Surgery, The University of Tokyo, Graduate School of Medicine, Tokyo, JP 113-8655, Japan.
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The Techniques of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:57-64. [DOI: 10.1097/imi.0b013e31820c91a7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for mediastinal lymph node staging in lung cancer patients as well as for the diagnosis of mediastinal and hilar adenopathy. The high diagnostic yield of EBUS-TBNA for lymph node staging has been shown in systematic reviews and meta-analysis. It has attracted physicians and surgeons as an alternative modality to surgical biopsy for the assessment of patients with enlarged mediastinal and/or hilar lymph nodes. Cell blocks obtained by EBUS-TBNA can be applicable not only for pathologic diagnosis but also for further investigations such as immunohistochemistry and fluorescence in situ hybridization. In addition, samples obtained by EBUS-TBNA can also be used for molecular analysis. Unlike regular bronchoscopy, EBUS-TBNA uses the convex probe EBUS with an ultrasound probe on the tip of a flexible bronchoscope. It is important for the bronchoscopist to fully understand the mediastinal anatomy and be able to correlate it with the ultrasound images for a successful EBUS-TBNA. The dedicated transbronchial needle used for EBUS-TBNA is somewhat different from an ordinary transbronchial biopsy forceps. Training is mandatory for achieving high diagnostic yield without complications. The learning curve of EBUS-TBNA is different from each physician, and continuous training program will be needed for impartiality. This article explains the detailed techniques of EBUS-TBNA to master this innovative procedure.
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The Techniques of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Huang CT, Chen CY, Ho CC, Yu CJ. A rare constellation of empyema, lung abscess, and mediastinal abscess as a complication of endobronchial ultrasound-guided transbronchial needle aspiration. Eur J Cardiothorac Surg 2010; 40:264-5. [PMID: 21183356 DOI: 10.1016/j.ejcts.2010.11.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 09/28/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022] Open
Abstract
The introduction of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) brought about significant advancement in the field of bronchoscopy. The major indications for EBUS-TBNA are lung cancer staging and diagnosis of mediastinal lymphadenopathy. This procedure is minimally invasive and cost saving, and no complications have been described in large-scale studies. In this report, we present a case of empyema, lung abscess, and mediastinal abscess that developed in a patient undergoing EBUS-TBNA; the patient subsequently recovered uneventfully after aggressive surgical debridement and antimicrobial therapy.
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Affiliation(s)
- Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
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Mediastinitis como complicación después de una punción-aspiración con aguja fina guiada por ecobroncoscopia. Arch Bronconeumol 2010; 46:567-8. [DOI: 10.1016/j.arbres.2010.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 06/05/2010] [Indexed: 11/20/2022]
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Complications of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. J Bronchology Interv Pulmonol 2010; 17:287-8. [DOI: 10.1097/lbr.0b013e3181f9eac8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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