Histological diagnosis of spinal chondrosarcoma by endobronchial ultrasound-guided transbronchial needle aspiration

Unusual diagnoses made by convex-probe endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) has proven to be an effective and minimally invasive tool to diagnose and stage lung cancer. However, its use for the diagnosis of rare mediastinal and lung pathologies has been rarely described. Hereby we describe a retrospective chart review of our EBUS-TBNA database for unusual diagnosis made between July 2012 and October 2016. Those conditions considered unusual for EBUS-TBNA diagnosis were identified and their medical records reviewed.

The role of endobronchial ultrasound/esophageal ultrasound for evaluation of the mediastinum in lung cancer

The introduction: of ultrasound-based, minimally invasive techniques (Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) and Esophageal Ultrasound guided Fine Needle Aspiration) has revolutionized care of patients with lung cancer needing mediastinal lymph node sampling. When combined, the techniques offer safe and accurate assessment of mediastinum, with accuracy surpassing that of the pervious gold standard - cervical mediastinoscopy. EBUS-TBNA can be used for mediastinal restaging in both, patients with suspected recurrence following treatment for primary lung cancer and followingneoadjuvant therapy in preparation for definitive surgical intervention. Both EBUS-TBNA and esophageal ultrasound guided fine needle aspiration techniques have been shown to provide sufficient material for molecular and DNA testing, extending their role beyond initial evaluation of the mediastinum to help direct and personalize medical treatment and predict response to therapy. In the future, assessing sonographic features of lymph nodesmay become useful in predicting nodal metastasis, further increasing the sensitivity of these techniques for detection of metastatic disease.

Metastatic chordoma detected by endobronchial ultrasound-guided transbronchial needle aspiration

Chordomas are rare, slow-growing malignant bone tumours arising from cellular remnants of the notochord. These tumours are locally invasive but have also a metastastic potential.Chordomas are characterized by the presence of physaliferous cells in a myxofibrillary stromal background. In cytological aspirates, these characteristic cells are usually absent, revealing only clusters of cells with varying degrees of vacuolation. This makes definitive diagnosis of chordoma difficult as the tumor can mimic other myxoid neoplasms including renal cell carcinomas and well-differentiated chondrosarcomas. In such situations, a confident diagnosis of chordoma requires comparison with histology of the primary tumor.We describe the first case of metastatic chordoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Advances in diagnostic bronchoscopy

Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.

Endobronchial Ultrasonography: Current Status and Future Directions

Endobronchial ultrasonography (EBUS) has emerged as a new diagnostic tool that allows the bronchoscopist to see beyond the airway. The radial probe EBUS was first introduced to evaluate the airway structure, which has been shown to be useful for identifying the extent of tumor invasion in the central airway. With advance in technology, smaller radial probes are now available that are capable of visualizing peripheral lung nodules. EBUS is also used as a tool to assist in a biopsy in respiratory diseases. The radial probe EBUS-guided transbronchial needle aspiration (TBNA) increases the yield of TBNA of mediastinal processes. By the use of the ultra-miniature probe EBUS along with the guide sheath, peripheral lung lesions can be accessed without the exposure to radiation. However, it is still not a real-time procedure with target visualization. The newest development is the convex probe EBUS (CP-EBUS) with a curvilinear electronic transducer on the tip of a flexible bronchovideoscope. CP-EBUS allows real-time EBUS-guided TBNA. Although the main indication for EBUS-TBNA is lymph node staging, it can also be used for diagnosis of intrapulmonary tumors, of unknown hilar and/or mediastinal lymphadenopathy, and of mediastinal tumors. To date, there are no reports of complications related to EBUS-guided TBNA. It is a novel approach that has a good diagnostic yield with excellent potential in assisting safe and accurate diagnostic interventional bronchoscopy. The aim of this review is to highlight the current status of the different EBUS techniques available and to discuss the future direction of EBUS.