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EUS-B-FNA Enhances the Diagnostic Yield of EBUS Bronchoscope for Intrathoracic Lesions. Lung 2022; 200:643-648. [PMID: 36074142 DOI: 10.1007/s00408-022-00563-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Endobronchial ultrasound (EBUS) bronchoscopes have been used mainly through the airway for EBUS-guided transbronchial needle aspiration (EBUS-TBNA); however, they can also be used through the esophagus. The esophageal approach, endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA), has gradually become popular, as it can evaluate lesions that cannot be accessed through the airway. PURPOSE This study aimed to evaluate the value of adding EUS-B-FNA to EBUS-TBNA performed by pulmonologists for intrathoracic lesions in the clinical setting. METHODS Between March 2009 and March 2020, all patients who underwent EUS-B-FNA and EBUS-TBNA for diagnostic purposes were included and retrospectively analyzed at a single institution. RESULTS A total of 1794 procedures using an EBUS bronchoscope including, EBUS-TBNA, EUS-B-FNA, and the combination of EBUS-TBNA and EUS-B-FNA for evaluating intrathoracic lesions, were performed. We finally analyzed 276 patients who underwent EUS-B-FNA for diagnostic purposes. EUS-B-FNA provided diagnostic materials from only EBUS-TBNA-inaccessible lesions in 26 patients and in 18 patients whose conditions were inappropriate for bronchoscopy (e.g., respiratory failure, airway stenosis, etc.). EUS-B-FNA provided diagnostic results in four patients with non-diagnostic EBUS-TBNA results. EUS-B-FNA was preferable to EBUS-TBNA in 4.4% (48 of 1091) of patients; therefore, adding EUS-B-FNA to EBUS-TBNA increased the diagnostic yield from 72.6% (1043 of 1437) to 75.9% (1091 of 1437). CONCLUSION Pulmonologists are able to enhance diagnostic yields by acquiring the EUS-B-FNA technique.
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Crombag LMM, Mooij-Kalverda K, Szlubowski A, Gnass M, Tournoy KG, Sun J, Oki M, Ninaber MK, Steinfort DP, Jennings BR, Liberman M, Bilaceroglu S, Bonta PI, Korevaar DA, Trisolini R, Annema JT. EBUS versus EUS-B for diagnosing sarcoidosis: The International Sarcoidosis Assessment (ISA) randomized clinical trial. Respirology 2021; 27:152-160. [PMID: 34792268 PMCID: PMC9299594 DOI: 10.1111/resp.14182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/15/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
Background and objective Endosonography with intrathoracic nodal sampling is proposed as the single test with the highest granuloma detection rate in suspected sarcoidosis stage I/II. However, most studies have been performed in limited geographical regions. Studies suggest that oesophageal endosonographic nodal sampling has higher diagnostic yield than endobronchial endosonographic nodal sampling, but a head‐to‐head comparison of both routes has never been performed. Methods Global (14 hospitals, nine countries, four continents) randomized clinical trial was conducted in consecutive patients with suspected sarcoidosis stage I/II presenting between May 2015 and August 2017. Using an endobronchial ultrasound (EBUS) scope, patients were randomized to EBUS or endoscopic ultrasound (EUS)‐B‐guided nodal sampling, and to 22‐ or 25‐G ProCore needle aspiration (2 × 2 factorial design). Granuloma detection rate was the primary study endpoint. Final diagnosis was based on cytology/pathology outcomes and clinical/radiological follow‐up at 6 months. Results A total of 358 patients were randomized: 185 patients to EBUS‐transbronchial needle aspiration (EBUS‐TBNA) and 173 to EUS‐B‐fine‐needle aspiration (FNA). Final diagnosis was sarcoidosis in 306 patients (86%). Granuloma detection rate was 70% (130/185; 95% CI, 63–76) for EBUS‐TBNA and 68% (118/173; 95% CI, 61–75) for EUS‐B‐FNA (p = 0.67). Sensitivity for diagnosing sarcoidosis was 78% (129/165; 95% CI, 71–84) for EBUS‐TBNA and 82% (115/141; 95% CI, 74–87) for EUS‐B‐FNA (p = 0.46). There was no significant difference between the two needle types in granuloma detection rate or sensitivity. Conclusion Granuloma detection rate of mediastinal/hilar nodes by endosonography in patients with suspected sarcoidosis stage I/II is high and similar for EBUS and EUS‐B. These findings imply that both diagnostic tests can be safely and universally used in suspected sarcoidosis patients. This global RCT in patients with suspected sarcoidosis stage I/II with an indication for endosonographic nodal sampling showed a similarly high granuloma detection rate and sensitivity for diagnosing sarcoidosis with endobronchial ultrasound versus endoscopic ultrasound‐B. The findings imply that both diagnostic tests (endobronchial/oesophageal) can be used safely and universally in suspected sarcoidosis patients.
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Affiliation(s)
- Laurence M M Crombag
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kirsten Mooij-Kalverda
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Maciej Gnass
- Endoscopy Unit, John Paul II Hospital, Kraków, Poland
| | - Kurt G Tournoy
- Department of Respiratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jiayuan Sun
- Department of Respiratory Endoscopy and Interventional Pulmonology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Maarten K Ninaber
- Department of Respiratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Barton R Jennings
- Department of Respiratory Medicine, Monash Health, Clayton, Victoria, Australia
| | - Moishe Liberman
- Division of Thoracic Surgery, University of Montreal, CR-CHUM, Montreal, Québec, Canada
| | - Semra Bilaceroglu
- Department of Respiratory Medicine, Health Sciences University, Izmir, Turkey.,Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Yenişehir Mahallesi, Izmir, Turkey
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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P B S, Mittal S, Madan K, Mohan A, Tiwari P, Hadda V. Endoscopic Ultrasound in the Diagnosis of Sarcoidosis: A Forgotten Tool? Am J Respir Crit Care Med 2020; 202:1320-1321. [PMID: 32678670 PMCID: PMC7605182 DOI: 10.1164/rccm.202004-1178le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sryma P B
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saurabh Mittal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karan Madan
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anant Mohan
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pawan Tiwari
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijay Hadda
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Patterson KC, Bonham CA, Wilson KC, Crouser ED, Baughman RP, Maier LA. Reply to P. B. et al., to Fahim and Rosewarne, and to Reich. Am J Respir Crit Care Med 2020; 202:1322-1324. [PMID: 32678671 PMCID: PMC7605203 DOI: 10.1164/rccm.202006-2328le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Karen C Patterson
- University of Pennsylvania, Philadelphia, Pennsylvania.,Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, Massachusetts
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Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 455] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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Pedro C, Melo N, Novais E Bastos H, Magalhães A, Fernandes G, Martins N, Morais A, Caetano Mota P. Role of Bronchoscopic Techniques in the Diagnosis of Thoracic Sarcoidosis. J Clin Med 2019; 8:jcm8091327. [PMID: 31466346 PMCID: PMC6780968 DOI: 10.3390/jcm8091327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/04/2019] [Accepted: 08/26/2019] [Indexed: 01/09/2023] Open
Abstract
The diagnosis of sarcoidosis relies on clinical and radiological presentation, evidence of non-caseating granulomas in histopathology and exclusion of alternative causes of granulomatous inflammation. Currently, a proper diagnosis, with a high level of confidence, is considered as key to the appropriate diagnosis and management of the disease. In this sense, this review aims to provide a brief overview on the role of bronchoscopy in the diagnosis of thoracic sarcoidosis, incorporating newer techniques to establish, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), transesophageal ultrasound-guided needle aspiration with the use of an echo bronchoscope (EUS-B-FNA) and transbronchial lung cryobiopsy (TBLC). Most of the literature reports the diagnostic superiority of endosonographic techniques, such as EBUS-TBNA alone or in combination with EUS-FNA, over conventional bronchoscopic modalities in diagnosing Scadding stages I and II of the disease. Moreover, TBLC may be considered a useful and safe diagnostic tool for thoracic sarcoidosis, overcoming some limitations of transbronchial lung biopsy (TBLB), avoiding more invasive modalities and being complementary to endosonographic procedures such as EBUS-TBNA.
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Affiliation(s)
- Cecília Pedro
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Natália Melo
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Hélder Novais E Bastos
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-319 Porto, Portugal
| | - Adriana Magalhães
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Gabriela Fernandes
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-319 Porto, Portugal
| | - António Morais
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Patrícia Caetano Mota
- Faculty of Medicine, University of Porto, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Pulmonology, Centro Hospitalar Universitário de São João, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
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Qin C, Wei B, Ma Z. Endobronchial ultrasound: Echoing in the field of pediatrics. Endosc Ultrasound 2018; 7:371-375. [PMID: 30289110 PMCID: PMC6289017 DOI: 10.4103/eus.eus_40_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023] Open
Abstract
Endobronchial ultrasound (EBUS) is a useful technique for the diagnosis and staging of the lung and mediastinal lesions, which is crucial for selecting treatment protocol. Under EBUS guidance, transbronchial needle aspiration (TBNA) is widely applied for obtaining specimens for histological, cytological, and molecular evaluation. Recently, the EBUS scope designed for adults has been used in large pediatric candidates. The presence of lung masses and mediastinal lymphadenopathy in the pediatric population presents a diagnostic challenge; however, EBUS is a promising tool for pediatricians to address these challenging issues. In some centers, the adult EBUS echobronchoscope is applied in transesophageal procedures for pediatric patients. EBUS-guided TBNA can also be used to perform minimally invasive interventional therapy, such as fiducial marker placement for assisting precision radiation, brachytherapy, and radiofrequency ablation therapy. With the development of EBUS equipment designed specifically for children, pediatric EBUS will play an increasingly important role.
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Affiliation(s)
- Can Qin
- Department of Pediatrics, General Hospital of Shenyang Military Area Command, Shenyang 110016, China
| | - Bing Wei
- Department of Pediatrics, General Hospital of Shenyang Military Area Command, Shenyang 110016, China
| | - Zhuang Ma
- Department of Respiratory, General Hospital of Shenyang Military Area Command, Shenyang 110016, China
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Prabhakar B, Shende P, Augustine S. Current trends and emerging diagnostic techniques for lung cancer. Biomed Pharmacother 2018; 106:1586-1599. [DOI: 10.1016/j.biopha.2018.07.145] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 12/20/2022] Open
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9
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Oki M, Saka H, Ando M, Nakashima H, Shiraki A, Murakami Y, Kogure Y, Kitagawa C, Kato T. How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study. Respiration 2018; 95:251-257. [PMID: 29320774 DOI: 10.1159/000485661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used as an initial diagnostic procedure for pathological confirmation of sarcoidosis, it is unclear how many passes are required to obtain diagnostic materials. OBJECTIVES The aim of this study was to determine the number of needle passes needed for the diagnosis of stage I/II sarcoidosis using EBUS-TBNA. METHODS At three institutions, 109 patients with suspected stage I/II sarcoidosis were recruited and underwent 6 passes of EBUS-TBNA for the main target lesion. Additional EBUS-TBNA for other lesions was permitted. The cumulative yields of needle passes for detecting noncaseating epithelioid cell granulomas were analyzed. RESULTS A total of 109 patients underwent EBUS-TBNA for 184 lesions. EBUS-TBNA identified specimens containing granulomas in 81 of 92 patients (88%) with a final diagnosis of sarcoidosis. The cumulative yields through the first, second, third, fourth, fifth, and sixth passes for the main target lesion were 63, 75, 82, 85, 86 and 88%, respectively. In the 55 patients that underwent EBUS-TBNA for multiple lesions, the cumulative yields of 2 passes per lesion for 2 lesions (total of 4 passes) and of 4 passes for single lesions were 86 and 84%, respectively (p = 1.00). CONCLUSIONS If rapid on-site cytological evaluation is not available, we recommend at least 4 passes per patient for either single or multiple lesions with EBUS-TBNA for pathological diagnosis of stage I/II sarcoidosis.
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Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Harunori Nakashima
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akira Shiraki
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasushi Murakami
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Chiyoe Kitagawa
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Tatsuo Kato
- Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan
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10
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Bugalho A, de Santis M, Slubowski A, Rozman A, Eberhardt R. Trans-esophageal endobronchial ultrasound-guided needle aspiration (EUS-B-NA): A road map for the chest physician. Pulmonology 2017; 24:S2173-5115(17)30162-8. [PMID: 29242047 DOI: 10.1016/j.rppnen.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/15/2017] [Indexed: 12/25/2022] Open
Abstract
The endobronchial ultrasound (EBUS) scope has been increasingly used in the gastrointestinal tract (EUS-B). Scientific data proves its efficacy and safety to provide a complete lung cancer staging, when combined with EBUS-TBNA, and in the diagnosis of para-esophageal lesions. There are multiple barriers to start performing EUS-B but probably the most important ones are related to knowledge and training, so new operators should follow a structured training curriculum. This review aims to reflect the best current knowledge regarding EUS-B and provide a road map to assist those who are incorporating the technique into their clinical practice.
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Affiliation(s)
- A Bugalho
- Pulmonology Unit, CUF Infante Santo Hospital, CUF Descobertas Hospital, Instituto CUF Oncologia (I.C.O.), Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal.
| | - M de Santis
- Serviço de Pneumologia, Instituto Português de Oncologia (IPO), Coimbra, Portugal.
| | - A Slubowski
- Endoscopy Unit, John Paul II Hospital, Krakow and Endoscopy Unit, Pulmonary Hospital Zakopane, Poland.
| | - A Rozman
- University Clinic of Pulmonary and Allergic Diseases Golnik, Slovenia.
| | - R Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.
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Mondoni M, Repossi A, Carlucci P, Centanni S, Sotgiu G. Bronchoscopic techniques in the management of patients with tuberculosis. Int J Infect Dis 2017; 64:27-37. [PMID: 28864395 DOI: 10.1016/j.ijid.2017.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/28/2017] [Accepted: 08/15/2017] [Indexed: 12/27/2022] Open
Abstract
Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis. We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB. We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting) and ablative procedures (both heat and cold therapies).
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Alice Repossi
- Respiratory Unit, Humanitas Gavazzeni Institute, Bergamo, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.
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Oki M, Saka H, Ando M, Tsuboi R, Nakahata M, Oka S, Kogure Y, Kitagawa C. Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions: a randomized study. Chest 2015; 147:1259-1266. [PMID: 25275701 DOI: 10.1378/chest.14-1283] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the tolerance, efficacy, and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with an endobronchial ultrasound scope for the first pathologic diagnosis of lesions accessible by both procedures. METHODS Patients who had lesions accessible by both EBUS-TBNA and EUS-FNA were enrolled and were randomized to undergo either procedure. Patients quantified tolerance, and operators charted the quality of examination using a 100-mm visual analog scale (VAS). RESULTS A specific diagnosis was made in 50 of 55 patients (91%) in the EBUS-TBNA group and in 48 of 55 patients (87%) in the EUS-FNA group (P = .76). Compared with EBUS-TBNA, EUS-FNA was associated with a shorter duration of procedure (median, 15.3 min vs 11.3 min; P < .001), lower doses of IV midazolam (mean, 4.4 mg vs 4 mg; P = .02) and intraairway lidocaine (mean, 303 mg vs 189 mg; P < .001), less frequent oxygen desaturations (23 of 55 vs two of 55, P < .001), and higher operator satisfaction (P < .001). There was no significant difference in patient tolerance according to the patients' VAS. Lymph node infection occurred in one patient in the EBUS-TBNA group and in two patients in the EUS-FNA group. CONCLUSIONS Both EBUS-TBNA and EUS-FNA provide high accuracy with good tolerance, although the occurrence of infectious complications should be monitored carefully. EUS-FNA has the advantage of comparable tolerance with fewer doses of anesthetics and sedatives, a shorter procedure time, and fewer oxygen desaturations during the procedure. TRIAL REGISTRY UMIN Clinical Trials Registry; No.: UMIN000005757; URL: http://www.umin.ac.jp/ctr/.
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Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan.
| | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Rie Tsuboi
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan
| | - Masashi Nakahata
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan
| | - Saori Oka
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan
| | - Chiyoe Kitagawa
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan
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Dhooria S, Aggarwal AN, Singh N, Gupta D, Behera D, Gupta N, Agarwal R. Endoscopic ultrasound-guided fine-needle aspiration with an echobronchoscope in undiagnosed mediastinal lymphadenopathy: First experience from India. Lung India 2015; 32:6-10. [PMID: 25624588 PMCID: PMC4298922 DOI: 10.4103/0970-2113.148399] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Several studies have reported the performance of combining endoscopic ultrasound fine-needle aspiration with an echobronchoscope (EUS-B-FNA), with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), for the diagnosis of mediastinal lymphadenopathy. Herein we report our initial experience with this technique. PATIENTS AND METHODS In this retrospective study, we report the outcome of patients who underwent EUS-B-FNA with or without EBUS-TBNA during the same session. Details of the lymph nodes sampled, number of passes, duration of the procedure, results of the cytological examination, and the final diagnosis of all the patients are presented. RESULTS Eleven patients underwent EUS-B-FNA during the study period. EUS-B-FNA and EBUS-TBNA together yielded a sensitivity and specificity of 72.7 and 100%, respectively. The number of lymph nodes sampled per patient and the number of passes per lymph node were significantly higher with EBUS-TBNA compared to EUS-B-FNA. The mean duration of procedure was also significantly higher in the EBUS-TBNA group. The most common reason (five patients (45.5%)) for resorting to EUS-B-FNA was the patient being unfit for EBUS-TBNA or the inability of the operator to complete the procedure. Sarcoidosis was the most frequent final diagnosis in the study patients (four cases), followed by bronchogenic carcinoma (three cases). CONCLUSIONS EUS-B-FNA is a useful additional tool for the diagnosis of mediastinal lymphadenopathy. In combination with EBUS-TBNA, it has a fairly good diagnostic yield and is a good alternative in situations where EBUS-TBNA is not feasible.
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Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Digamber Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Nalini Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non–small cell lung cancer? J Thorac Cardiovasc Surg 2014; 148:1169-77. [DOI: 10.1016/j.jtcvs.2014.05.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/29/2014] [Accepted: 05/06/2014] [Indexed: 12/25/2022]
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15
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Affiliation(s)
- A R L Medford
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
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16
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Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ando M. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration 2013; 85:486-92. [PMID: 23571718 DOI: 10.1159/000346987] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/27/2012] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Although rapid on-site cytologic evaluation (ROSE) is widely used during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), its role remains unclear. OBJECTIVES The purpose of the present study was to evaluate the efficacy of ROSE during EBUS-TBNA in the diagnosis of lung cancer. METHODS One hundred and twenty patients highly suspected of having lung cancer who had hilar/mediastinal lymphadenopathy or a tumor adjacent to the central airway were enrolled in this study and randomized to undergo EBUS-TBNA with or without ROSE. RESULTS Twelve patients with visible endobronchial lesions were excluded in the analysis. Thus, a total of 108 patients (55 in the ROSE group, 53 in the non-ROSE group) were analyzed. Additional procedures including EBUS-TBNA for lesions other than the main target lesion and/or transbronchial biopsy in the same setting were performed in 11% of patients in the ROSE group and 57% in the non-ROSE group (p < 0.001). Mean puncture number was significantly lower in the ROSE group (2.2 vs. 3.1 punctures, p < 0.001), and mean bronchoscopy time was similar between both groups (22.3 vs. 22.1 min, p = 0.95). The sensitivity and accuracy for diagnosing lung cancer were 88 and 89% in the ROSE group, and 86 and 89% in the non-ROSE group, respectively. No complications were associated with the procedures. CONCLUSIONS ROSE during EBUS-TBNA is associated with a significantly lower need for additional bronchoscopic procedures and puncture number.
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Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
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