1
|
Steinfort DP, Evison M, Witt A, Tsaknis G, Kheir F, Manners D, Madan K, Sidhu C, Fantin A, Korevaar DA, Van Der Heijden EHFM. Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement. Respirology 2023; 28:722-743. [PMID: 37463832 DOI: 10.1111/resp.14549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Since their introduction, both linear and radial endobronchial ultrasound (EBUS) have become an integral component of the practice of Pulmonology and Thoracic Oncology. The quality of health care can be measured by comparing the performance of an individual or a health service with an ideal threshold or benchmark. The taskforce sought to evaluate quality indicators in EBUS bronchoscopy based on clinical relevance/importance and on the basis that observed significant variation in outcomes indicates potential for improvement in health care outcomes. METHODS A comprehensive literature review informed the composition of a comprehensive list of candidate quality indicators in EBUS. A multiple-round modified Delphi consensus process was subsequently performed with the aim of reaching consensus over a final list of quality indicators and performance targets for these indicators. Standard reporting items were developed, with a strong preference for items where evidence demonstrates a relationship with quality indicator outcomes. RESULTS Twelve quality Indicators are proposed, with performance targets supported by evidence from the literature. Standardized reporting items for both radial and linear EBUS are recommended, with evidence supporting their utility in assessing procedural outcomes presented. CONCLUSION This statement is intended to provide a framework for individual proceduralists to assess the quality of EBUS they provide their patients through the identification of clinically relevant, feasible quality measures. Emphasis is placed on outcome measures, with a preference for consistent terminology to allow communication and benchmarking between centres.
Collapse
Affiliation(s)
- Daniel P Steinfort
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashleigh Witt
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Georgios Tsaknis
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, Kettering General Hospital, UK
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Manners
- St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Alberto Fantin
- Department of Pulmonology, University Hospital of Udine (ASUFC), Udine, Italy
| | - Daniel A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
2
|
Diab K, Costanian C, Bikak M, Al Nasrallah N, Al-Hader AA, Bendaly E, Zhang C, Assi R. Diagnostic Yield of Endobronchial Ultrasound-Guided Mediastinal Lymph Node Transbronchial Forceps Biopsies (EBUS-TBFB). South Med J 2023; 116:202-207. [PMID: 36724536 DOI: 10.14423/smj.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The diagnostic accuracy and yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is not well established in lymphoma and other mediastinal-related diseases. The objective of this study was to examine the yield of a combined technique of EBUS-TBNA and endobronchial ultrasound-guided transbronchial forceps biopsies (EBUS-TBFB) compared with each modality alone in lymphoma and other mediastinal-related diseases. METHODS This was a retrospective review of cases of mediastinal lymphadenopathy of unknown etiology accessed using TBNA and TBFB. The McNemar test was used to compare the diagnostic yield of TBNA, TBFB, and the combined technique. RESULTS The combined approach yielded a definitive diagnosis in 31/35 cases (88.6%). In 9/10 cases (90%), Hodgkin's and non-Hodgkin's lymphomas were diagnosed and subtyped without further need for invasive testing. All of the granulomatous inflammation cases were confirmed using the combined technique. Two cases led to adequate whole-genome sequencing of lung cancer, and one patient was diagnosed as having dedifferentiated liposarcoma despite a nondiagnostic preprocedural mediastinoscopy. There was only one procedure-related complication, a pneumomediastinum that required no further intervention. There were no significant adverse events. CONCLUSIONS The combination of EBUS-TBFB and EBUS-TBNA is safe and provides a high yield in the diagnosis of mediastinal adenopathy of unknown etiology, especially lymphoma. Furthermore, the larger samples obtained from TBFB increased its sensitivity to detect granulomatous disease and provided specimens for clinical trials of malignancy when needle aspirates were insufficient.
Collapse
Affiliation(s)
- Khalil Diab
- From the Division of Pulmonary and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Christy Costanian
- the Department of Biostatistics and Oncology, Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine, Blat, Lebanon
| | - Marvi Bikak
- the Department of Pulmonary Medicine, Palos Health, Chicago, Illinois
| | - Nawar Al Nasrallah
- the Divisions of Pulmonary and Critical Care Medicine, and Hematology and Oncology, Indiana University School of Medicine, Bloomington
| | - Ahmad A Al-Hader
- the Divisions of Pulmonary and Critical Care Medicine, and Hematology and Oncology, Indiana University School of Medicine, Bloomington
| | - Edmond Bendaly
- the Department of Hematology and Oncology, Marion General Hospital, Marion, Indiana
| | - Chen Zhang
- the Divisions of Pulmonary and Critical Care Medicine, and Hematology and Oncology, Indiana University School of Medicine, Bloomington
| | - Rita Assi
- the Department of Biostatistics and Oncology, Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine, Blat, Lebanon
| |
Collapse
|
3
|
Touil I, Ibn Hadj Amor H, Brahem Y, Bouchareb S, Ayeb J, Boussoffara L, Boudawara NK, Knani J. Pulmonary MALT lymphoma associated with interstitial pulmonary disease. Respir Med Case Rep 2022; 36:101598. [PMID: 35169539 PMCID: PMC8829808 DOI: 10.1016/j.rmcr.2022.101598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/19/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Interstitial lung disease (ILD) and low-grade Mucosa-associated B-cell lymphoma (MALT lymphoma) are two different disorders of the respiratory system. In some cases, pulmonary MALT lymphoma is seen presenting with interstitial lung disease. We report a case of 42-year-old man presenting with a pulmonary MALT lymphoma associated with interstitial lung disease.
Collapse
|
4
|
Carbonari A, Rossini L, Marioni F, Camunha M, Saieg M, Bernardi F, Maluf F, Botter M, Dorgan V, Saad R. Value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of lung and mediastinal lesions. ACTA ACUST UNITED AC 2020; 66:1210-1216. [PMID: 33027447 DOI: 10.1590/1806-9282.66.9.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the value of EBUS-TBNA in the diagnosis of lung and mediastinal lesions. METHODS Prospective cohort study that included 52 patients during a 2-year period (2016 to 2018) who underwent EBUS-TBNA. RESULTS Among the 52 individuals submitted to the procedure, 22 (42.31%) patients were diagnosed with locally advanced lung cancer (N2 or N3 lymph node involvement). EBUS-TBNA confirmed the diagnosis of metastases from other extrathoracic tumors in the mediastinum or lung in 5 patients (9.61%), confirmed small cell lung cancer in 3 patients (5.76%), mediastinal sarcoidosis in 1 patient (1.92%), and reactive mediastinal lymph node in 8 patients (15.38%); insufficient results were found for 3 patients (5.76%). Based on these results, EBUS-TBNA avoided further subsequent surgical procedures in 39 of 52 patients (75%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 100%, 100%, 77%, and 90%, respectively. No major complications were observed. CONCLUSIONS EBUS-TBNA is a safe, effective, and valuable method. This technique can significantly reduce the rate of subsequent surgical procedures required for the diagnosis of lung and mediastinal lesions.
Collapse
Affiliation(s)
- Augusto Carbonari
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Lucio Rossini
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Fabio Marioni
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Marco Camunha
- Hospital Santa Casa de São Paulo - Departamento de Endoscopia e Centro Franco Brasileiro de Ecoendoscopia (CFBEUS), São Paulo, SP, Brasil
| | - Mauro Saieg
- Hospital Santa Casa de São Paulo - Departamento de Patologia, São Paulo, SP, Brasil
| | - Fabiola Bernardi
- Hospital Santa Casa de São Paulo - Departamento de Patologia, São Paulo, SP, Brasil
| | - Fernando Maluf
- Hospital Santa Casa de São Paulo - Departamento de Oncologia, São Paulo, SP, Brasil
| | - Marcio Botter
- Hospital Santa Casa de São Paulo - Departamento de Cirurgia Toráxica, São Paulo, SP, Brasil
| | - Vicente Dorgan
- Hospital Santa Casa de São Paulo - Departamento de Cirurgia Toráxica, São Paulo, SP, Brasil
| | - Roberto Saad
- Hospital Santa Casa de São Paulo - Departamento de Cirurgia Toráxica, São Paulo, SP, Brasil
| |
Collapse
|
5
|
Diagnostic Accuracy of Endobronchial Ultrasound Transbronchial Needle Aspiration in Lymphoma. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2019; 16:1432-1439. [DOI: 10.1513/annalsats.201902-175oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
6
|
Di Felice C, Young B, Matta M. Comparison of specimen adequacy and diagnostic accuracy of a 25-gauge and 22-gauge needle in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2019; 11:3643-3649. [PMID: 31559072 DOI: 10.21037/jtd.2019.04.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the preferred diagnostic modality for sampling mediastinal and hilar lymph nodes (LNs). The conventional needle used for sampling is either a 21-gauge (21G) or 22-gauge (22G). A 25-gauge (25G) needle has recently been introduced with little known regarding its efficacy. Methods A retrospective study was conducted on patients referred for EBUS-TBNA who had LNs sampled using a 25G or 22G needle. A propensity score matching analysis was performed. After matching the groups, each LN was assessed for adequacy and final diagnosis. Non-diagnostic and benign lymphoid specimens were compared with repeat biopsy findings or long-term clinical and radiological follow-up. Results A total of 158 LNs were included. An adequate sample was obtained in 92.4% (73/79) in the 25G group and 92.4% (73/79) in the 22G group (P=1). The 25G group diagnosed benign lymphoid tissue in 82.3% (65/79), granuloma in 7.6% (6/79) and malignancy in 2.5% (2/79). Six lymph nodes in the 25G group were non-diagnostic (7.6%). The 22G group diagnosed benign lymphoid tissue in 83.5% (66/79), granuloma in 3.8% (3/79) and malignancy in 5.1% (4/79). Six lymph nodes in the 22G group were non-diagnostic (7.6%). The sensitivity, specificity, negative predictive value (NPV) and diagnostic accuracy in the 25G group was 88.9% (95% CI, 51.8-99.7%), 100% (95% CI, 92.1-100%), 97.8% (95% CI, 87.6-99.7%) and 98.2% (95% CI, 90.1-100%), respectively. The sensitivity, specificity, NPV and diagnostic accuracy in the 22G group was 77.8% (95% CI, 40-97.2%), 100% (95% CI, 86.8-100%), 92.9% (95% CI, 79.3-97.8%) and 94.3% (95% CI, 80.8-99.3%), respectively. The 25G and 22G group were comparable in diagnostic accuracy (P=0.7). Conclusions The 25G and 22G needle achieve comparable specimen adequacy and diagnostic accuracy in EBUS-TBNA.
Collapse
Affiliation(s)
- Christopher Di Felice
- University Hospitals Cleveland Medical Center, Department of Pulmonary, Critical Care and Sleep Medicine, Cleveland, Ohio, USA
| | - Benjamin Young
- University Hospitals Cleveland Medical Center, Department of Pulmonary, Critical Care and Sleep Medicine, Cleveland, Ohio, USA
| | - Maroun Matta
- University Hospitals Cleveland Medical Center, Department of Pulmonary, Critical Care and Sleep Medicine, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Lin X, Ye M, Li Y, Ren J, Lou Q, Li Y, Jin X, Wang KP, Chen C. Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy. BMC Pulm Med 2018; 18:192. [PMID: 30526587 PMCID: PMC6286611 DOI: 10.1186/s12890-018-0751-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/22/2018] [Indexed: 12/25/2022] Open
Abstract
Background The optimal procedure for maximizing the diagnostic yield and minimizing the procedural complexity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is controversial. We conducted a prospective randomized controlled trial to determine the optimal procedure of EBUS-TBNA for mediastinal and hilar lymphadenopathy, with a particular focus on the roles of the inner-stylet and suction. Methods Consecutive patients with enlarged mediastinal and hilar lymph nodes (LNs), detected by computed tomography (CT) or positron emission tomography-CT (PET-CT), who underwent EBUS-TBNA were included. Each LN was sampled with three needle passes using suction–stylet, suction–no stylet, and stylet–no suction procedures. The samples were smeared onto glass slides for cytological evaluation. A single, blinded cytopathologist evaluated each set of slides. The primary outcomes were cytological specimen adequacy rate and diagnostic yield of malignant LNs. The secondary outcomes were tissue-core acquisition rate, procedural time, and the amount of bleeding. Results This study evaluated 97 patients with a total of 255 LNs. The final LN diagnosis was benign in 144, malignant in 104, and inadequate in 7 cases. There were no significant differences among the suction–stylet, suction–no stylet, and stylet–no suction groups in specimen adequacy rate (87.1, 88.2, 85.9%, respectively) or diagnostic yield of malignancy (32.2, 31.8, 31.0%, respectively). However, the use of suction was associated with an increase in tissue-core acquisition rate (P < 0.001). The no-stylet procedure decreased the average procedural time by 14 s (P < 0.001). There was no significant difference in the amount of bleeding among the procedures. Conclusions The use of suction or non-use of an inner-stylet does not make a significant difference in cytological specimen adequacy or diagnostic yield when performing EBUS-TBNA. While omitting the stylet can simplify the procedure, applying suction can increase the tissue-core acquisition rate. These findings may assist endoscopic physicians in determining the optimal EBUS-TBNA procedure and warrant clinical verification in a future multicentre study. Trial registration Trial registration: (ChiCTR-IOR-17010616). Retrospective registered date: 12th February, 2017.
Collapse
Affiliation(s)
- Xiaoxiao Lin
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Min Ye
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Jing Ren
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Qiyan Lou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Yangyang Li
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Xiaohui Jin
- Department of Endoscopy, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Ko-Pen Wang
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Chengshui Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Li P, Wu C, Zheng W, Zhao L. Pathway and application value of exploration of the pulmonary artery by endobronchial ultrasound. J Thorac Dis 2017; 9:5345-5351. [PMID: 29312744 DOI: 10.21037/jtd.2017.12.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The current standard methods for detecting pulmonary artery diseases are pulmonary artery enhanced computed tomography (CT) scan and pulmonary arteriography. However, some patients cannot tolerate these procedures for various reasons. The present study aimed to investigate the feasibility and operation process of endobronchial ultrasound (EBUS) in exploring the pulmonary artery. Methods Based on normal contrast-enhanced chest CT images, the sites and process for exploring the pulmonary arteries were established. Then the feasibility of the exploration by the convex probe EBUS were evaluated, and roadmaps for exploration of the pulmonary arteries were drawn. Results Among patients who underwent pulmonary artery exploration, sonograms of the left and right pulmonary artery were obtained by the convex probe EBUS. The above-mentioned pulmonary artery branches can be positioned by means of anatomical markers under the bronchoscopic view and follow a certain route for continuous exploration. Sonograms had a certain degree of identification and can be used as an auxiliary tool for pulmonary artery exploration. Conclusions EBUS can be used to explore the main branches of the pulmonary artery continuously. Therefore, EBUS could be considered as a candidate for the diagnosis of pulmonary artery diseases in a selected group of patients, i.e., patient with contrast allergy or renal failure.
Collapse
Affiliation(s)
- Peng Li
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Cen Wu
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wei Zheng
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Li Zhao
- The 1st Department of Respiratory Medicine and Medical Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| |
Collapse
|
10
|
Yang H, Wang S, Teng J, Han B, Sun J. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing non-specific inflammatory intrathorcacic lymphadenitis. CLINICAL RESPIRATORY JOURNAL 2016; 12:691-698. [PMID: 27882677 DOI: 10.1111/crj.12580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/16/2016] [Accepted: 11/01/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive technique for diagnosing intrathoracic malignancies and some benignancies; however, there are no data available on the utility of EBUS-TBNA for the diagnosis of non-specific inflammatory intrathoracic lymphadenitis. METHODS A prospective analysis was performed from 104 patients with enlarged lymphadenopathy suspected of non-specific lymphadenitis referred for EBUS-TBNA between October 2009 and March 2012. Rapid on-site cytological evaluation was not adopted. Microbiological tests were carried out in all patients. Patients were excluded from the study if there was other diagnosis being defined. RESULTS One hundred ninety-one lesions were aspirated in 94 patients with enlarged mediastinal/hilar lymph nodes within reach of EBUS-TBNA, which were diagnosed as non-specific intrathorcacic lymphadenitis by pathology and clinical follow-up. According to EBUS-TBNA pathologies, 94 patients were categorized into four kinds: (i) inflammatory cell infiltrates and/or noncaseating necrosis in 38 cases; (ii) granuloma formed by epithelioid cells and/or fiber hyperplasia in 13 cases; (iii) lymph node tissue/lymphocyte without obvious abnormal lesions in 41 cases; (iv) inadequate sample in 2 cases. Bacterial and/or fungal smears and cultures were carried out in all 94 patients (100%), with pathogens being found in 4 (4.3%) cases. All patients (100%) underwent acid-fast staining and culture for mycobacterium tuberculosis to exclude tuberculosis. No procedure-related complication was observed. CONCLUSIONS EBUS-TBNA can provide pathological and microbiological evidences for diagnosing non-specific inflammatory intrathoracic lymphadenopathy, and it is a safe and effective first-line investigation for ruling out malignancies and other benign diseases.
Collapse
Affiliation(s)
- Huizhen Yang
- Department of Endoscopy, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, People's Republic of China.,Department of Respiratory and Critical Care Medicine, People's Hospital of Zhengzhou University, Zhengzhou, 450003, People's Republic of China
| | - Shenglan Wang
- Department of Pulmonary Medicine, First People's Hospital of Yunnan Province, Kunming, 650000, People's Republic of China
| | - Jiajun Teng
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, People's Republic of China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, People's Republic of China
| | - Jiayuan Sun
- Department of Endoscopy, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, People's Republic of China
| |
Collapse
|