1
|
Ortiz-Pacheco R, Sinha T, Ghattas C, Pannu J, Willis J, Revelo A, Pastis N. An update on the minimally invasive diagnosis of lymphoma for the chest physicians. Respir Med 2024; 233:107765. [PMID: 39181276 DOI: 10.1016/j.rmed.2024.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/22/2024] [Accepted: 08/10/2024] [Indexed: 08/27/2024]
Abstract
Mediastinal lymphadenopathy has a broad differential diagnosis which includes lymphoma. The current preferred biopsy technique for mediastinal lymph nodes is transbronchial needle aspiration which has mixed results in terms of sensitivity, specificity and diagnostic yields; there are also limitations with subtyping lymphomas with needle aspiration alone which can be a barrier to determine management strategies. Invasive mediastinal lymph node sampling such was with mediastinoscopy provides higher yields and preserved lymph node architecture for both diagnosis and subtyping of lymphoma but carries a higher risk of morbidity and complications. Novel techniques that may increase the diagnostic yield of bronchoscopy in the diagnosis of lymphoma are core biopsy needles, intranodal forcep biopsy, and intranodal cryobiopsy. The evidence is limited due to a relatively small number of cases, so further research is needed to standardize best practices for the bronchoscopic diagnosis of lymphoma. Pleural effusions in lymphoma can be present in up to 30 % of cases with the majority being non-Hodgkins's lymphoma. The presence of exudative effusion in the setting of an existing or prior diagnosis of lymphoma should raise clinical suspicions. Other less common subtypes of lymphoma presenting as primary pleural effusions are explored as well.
Collapse
Affiliation(s)
- Ronaldo Ortiz-Pacheco
- The University of Vermont Division of Pulmonary Disease and Critical Care Medicine, USA
| | - Tejas Sinha
- The Ohio State University Division of Pulmonary, Critical Care, and Sleep Medicine, USA
| | - Christian Ghattas
- The Ohio State University Division of Pulmonary, Critical Care, and Sleep Medicine, USA
| | - Jasleen Pannu
- The Ohio State University Division of Pulmonary, Critical Care, and Sleep Medicine, USA
| | - Jason Willis
- The Ohio State University Department of Pathology, USA
| | - Alberto Revelo
- The Ohio State University Division of Pulmonary, Critical Care, and Sleep Medicine, USA
| | - Nicholas Pastis
- The Ohio State University Division of Pulmonary, Critical Care, and Sleep Medicine, USA.
| |
Collapse
|
2
|
Effect of Needle Size on Diagnosis of Sarcoidosis with Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2022; 19:279-290. [PMID: 35103562 DOI: 10.1513/annalsats.202103-366oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Sarcoidosis is a multisystem disease characterized by noncaseating granulomatous inflammation that most commonly involves the lungs. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an invaluable tool in the assessment of patients with mediastinal and/or hilar lymphadenopathy. Objective: It has been hypothesized that use of the larger 19-gauge (G) needle with EBUS-TBNA improves diagnostic sensitivity in sarcoidosis. However, it is unclear whether the existing literature supports this supposition. Data Sources: A literature search of Embase and Medline was performed by two reviewers. Included articles were evaluated for bias using the QUADAS-2 tool. Data Extraction: For quantitative analysis, we performed a meta-analysis using a binary random-effects model to determine pooled sensitivity. Subgroup analysis was performed based on needle size, use of rapid on-site evaluation (ROSE), study design, and prevalence of sarcoidosis in study group. Synthesis: Sixty-five studies with a total of 4,242 patients were included in the meta-analysis. Overall pooled sensitivity for diagnosis of sarcoidosis was 83.99% (95% confidence interval [CI], 81.22-86.53) among all studies. The 19G subgroup had a significantly higher sensitivity (93.73%; 95% CI, 89.72-97.74%; I2 = 0.00%; P < 0.01) compared with the 21G subgroup (84.61%; 95% CI, 78.80-90.42%; I2 = 69.83%), 22G subgroup (84.07%; 95% CI, 80.90-87.24%; I2 = 85.21%) or unspecified 21G/22G subgroup (78.85%; 95% CI, 70.81-86.90%; I2 = 84.47%). There were no significant differences with use of ROSE or prevalence of sarcoidosis or by study design. Conclusions: The use of 19G needles during EBUS-TBNA had the highest diagnostic sensitivity based on available studies. Further randomized controlled trials using 19G needles should be considered in patients with suspected sarcoidosis.
Collapse
|
3
|
Franzen D, Schneiter D, Weder W, Kohler M. Impact of sedation technique on the diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration. Endosc Ultrasound 2017; 6:257-263. [PMID: 28663531 PMCID: PMC5579912 DOI: 10.4103/2303-9027.190925] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives: There is a paucity of data concerning the impact of the sedation technique used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) on diagnostic accuracy. The aim of this retrospective study was to compare the diagnostic accuracy of EBUS-TBNA in deep and moderate sedations, and to investigate other possible determinants of diagnostic accuracy in three lymph node locations (mediastinal, subcarinal, and hilar). Materials and Methods: The first consecutive patients at our institution undergoing EBUS-TBNA for selective sampling in deep sedation were compared with the first consecutive patients in moderate sedation between 2006 and 2014. Diagnoses based on EBUS-TBNA were compared with those on surgical or radiological follow-up. Results: In a total of 232 patients, the overall diagnostic accuracy for correct diagnosis at the mediastinal, subcarinal, and hilar locations irrespective of the sedation technique was 91%, 93%, and 92%, respectively. At the three mentioned lymph node locations, overall diagnostic accuracy of EBUS-TBNA in deep sedation compared to moderate sedation was 88.5% and 95.5% (P = 0.3), 93.2 and 93.6% (P = 0.9), and 88.6 and 94.0% (P = 0.4), respectively. Conclusions: The sedation technique does not seem to influence the diagnostic accuracy of EBUS-TBNA.
Collapse
Affiliation(s)
- Daniel Franzen
- Division of Pulmonology, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| |
Collapse
|
4
|
Sørhaug S, Hjelde H, Hatlen P, Leira HO, Salarinejad M, Nesvik B, Hollund R, Nesgård K, Nordhaug DO, Amundsen T. Learning endobronchial ultrasound transbronchial needle aspiration - a 6-year experience at a single institution. CLINICAL RESPIRATORY JOURNAL 2016; 12:40-47. [DOI: 10.1111/crj.12475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/03/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Sveinung Sørhaug
- Department of Thoracic Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Harald Hjelde
- Department of Thoracic Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Peter Hatlen
- Department of Thoracic Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Håkon Olav Leira
- Department of Thoracic Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Majid Salarinejad
- Department of Pathology; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Bjarte Nesvik
- Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - Raymond Hollund
- Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - Kristin Nesgård
- Department of Radiology; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Dag Ole Nordhaug
- Department of Thoracic Surgery; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
| | - Tore Amundsen
- Department of Thoracic Medicine; St. Olavs Hospital, Trondheim University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| |
Collapse
|
5
|
Osinka K, Zielińska-Krawczyk M, Korczyński P, Górnicka B, Krenke R. Impact of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration on Diagnostic Yield of Bronchoscopy in Patients with Mediastinal Lymph Node Enlargement. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 911:33-43. [PMID: 26987324 DOI: 10.1007/5584_2016_222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) had an enormous impact on the current advancement in diagnostic bronchoscopy. The aims of the present study were: (1) to evaluate the added value of EBUS-TBNA to routine diagnostic bronchoscopy performed in patients with mediastinal lymph node enlargement and (2) to identify factors that affect the diagnostic yield of EBUS-TBNA. We retrospectively analyzed 712 EBUS-TBNA procedures out of the 4081 bronchoscopies performed in the years 2009-2014. The number of EBUS-TBNA procedures increased from 61 (8.8 % of all bronchoscopies) in 2009 to 160 (21.4 %) in 2014. In 625 (87.8 %) patients adequate cytological material was obtained. Based on cytological examination of EBUS-TBNA aspirates, specific diagnosis was made in 367 (51.5 %) patients. The forceps biopsy of endobronchial lesions provided specific diagnosis in only 204 (28.6 %) patients. The percentage of patients with EBUS-TBNA based diagnosis increased steadily from 34.4 % in 2009 to 65.0 % in 2014 (p < 0.0001). The median lymph node diameter in patients with positive EBUS-TBNA findings was 20 (IQR 15-30) mm and was significantly larger than that in patients with negative EBUS-TBNA results (15 (IQR 10-20) mm, p = 0.0001). The highest diagnostic yield (78.5 %) was found in patients with lymph node dimension between 31 mm and 40 mm. We conclude that EBUS-TBNA is a valuable diagnostic method in an unselected group of patients with mediastinal lymph node enlargement. The percentage of positive EBUS-TBNA diagnoses is related to lymph node dimensions. The overall efficacy of EBUS-TBNA improves with increasing years of experience.
Collapse
Affiliation(s)
- K Osinka
- Medical Student Research Group 'Alveolous', Medical University of Warsaw, Warsaw, Poland
| | - M Zielińska-Krawczyk
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland
| | - P Korczyński
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland.
| | - B Górnicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - R Krenke
- Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland
| |
Collapse
|
6
|
|
7
|
Koo HJ, Kim MY, Shin SY, Shin S, Kim SS, Lee SW, Choi CM. Evaluation of Mediastinal Lymph Nodes in Sarcoidosis, Sarcoid Reaction, and Malignant Lymph Nodes Using CT and FDG-PET/CT. Medicine (Baltimore) 2015; 94:e1095. [PMID: 26166096 PMCID: PMC4504536 DOI: 10.1097/md.0000000000001095] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to analyze the clinical, computed tomography (CT), and positron emission tomography (PET) findings of sarcoidosis, sarcoid reaction, and malignant lymph nodes (LNs) to the results of transbronchial LN aspiration and biopsy (TBNA).The TBNA results of mediastinal and hilar LNs of 152 patients in our hospital from July 2008 to March 2013 were retrospectively reviewed. Two independent radiologists measured the size and attenuation of LNs on CT and assessed the probability of the 3 categories: sarcoidosis (n = 36), sarcoid reaction (n = 25), or malignant LNs (n = 91). The total volume and attenuation of LNs were measured using Image J (NIH). The median maximum standardized uptake value (maxSUV) of the 3 mediastinal and hilar LNs on PET/CT was obtained.There was no significantly different CT finding between sarcoidosis and sarcoid reaction. Multivariate analysis showed that the age, total volume of LNs, and number of enlarged LNs significantly differed between sarcoid reaction and malignant LNs. Sarcoid reaction tends to be occurred in young patients (P = 0.007), the total volume of LNs was smaller (P = 0.04) than that of malignant LNs, and there were significantly more LNs >1 cm (P = 0.005). The median maxSUV of the 3 highest SUVs of the LNs did not significantly differ between the 3 entities.
Collapse
Affiliation(s)
- Hyun Jung Koo
- From the Department of Radiology and Research Institute of Radiology (HJK, MYK, SYS), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Diagnostic Radiology (SS), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Healthcare Management (S-SK), Cheongju University, Cheongju, Republic of Korea; Pulmonary and Critical Care Medicine (SWL, C-MC), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; and Division of Oncology (C-MC), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
8
|
Trisolini R, Lazzari Agli L, Tinelli C, De Silvestri A, Scotti V, Patelli M. Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis of sarcoidosis in clinically unselected study populations. Respirology 2014; 20:226-34. [PMID: 25477156 DOI: 10.1111/resp.12449] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/31/2014] [Accepted: 10/21/2014] [Indexed: 12/19/2022]
Abstract
Literature suggests that ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has excellent performance characteristics for diagnosis of sarcoidosis. However, many authors challenge the external validity of EBUS-TBNA results, as most studies were performed in referral centres by highly experienced investigators, and included populations with very high sarcoidosis prevalence. We performed a systematic review and meta-analysis to estimate the role of EBUS-TBNA for diagnosis of sarcoidosis in studies enrolling consecutive patients with lymphadenopathy detected at imaging studies, regardless of the suspected underlying clinical aetiology. The Pubmed, Embase, Cinahl, Web of Science and Cochrane Library databases were screened to identify the pertinent literature. Quality of eligible studies was assessed by Quality Assessment, Data Abstraction and Synthesis-2 criteria. Pooled diagnostic yield, sensitivity and specificity were calculated, and a summary receiver operating characteristic curve was constructed. Subgroup analysis was planned to identify possible sources of study heterogeneity. Fourteen studies, collectively involving 2097 patients, fulfilled eligibility criteria. The median prevalence of sarcoidosis was 15%. EBUS-TBNA had a pooled diagnostic yield of 0.79 (standard deviation, 0.24), a pooled sensitivity of 0.84 (95% confidence interval (CI), 0.79-0.88) and a pooled specificity of 1.00 (95% CI, 0.99-1.00). Only subgroup analysis exploring the influence of study design seemed to influence the observed inter-study heterogeneity for sensitivity, retrospective studies showing worst sensitivity than prospective ones. The results of EBUS-TBNA for diagnosis of sarcoidosis in clinically unselected populations are excellent and compare favourably with published results from studies conducted in selected populations. High-quality trials would be needed to evaluate factors possibly explaining the observed heterogeneity in sensitivity.
Collapse
Affiliation(s)
- Rocco Trisolini
- Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy
| | | | | | | | | | | |
Collapse
|
9
|
Sailer V, Kristiansen G. Histopathological screening for prostate carcinoma: is a benign biopsy a negative biopsy? APMIS 2014; 122:690-8. [DOI: 10.1111/apm.12291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/14/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Verena Sailer
- Institute of Pathology; University Hospital of Bonn; Bonn Germany
| | - Glen Kristiansen
- Institute of Pathology; University Hospital of Bonn; Bonn Germany
| |
Collapse
|