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Al Sona M, Esivue O, Benzaquen S. Endobronchial ultrasound (EBUS)-guided transbronchial miniforceps biopsy an urban center experience. J Thorac Dis 2024; 16:183-190. [PMID: 38410576 PMCID: PMC10894409 DOI: 10.21037/jtd-23-884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in staging mediastinal and hilar lymph nodes in non-small cell lung cancer (NSCLC) is well established. However, evidence of its diagnostic utility in other pathologies-such as lymphoma-remains inadequate. This retrospective observational study aims to determine the diagnostic yield of EBUS-guided miniforceps biopsy (EBUS-MFB) compared to EBUS-TBNA in both malignant and nonmalignant conditions. Methods We conducted a retrospective cross-sectional chart review of all adult patients referred for EBUS at our institution between January 2019 and December 2022. All patients who underwent both EBUS-TBNA and EBUS-MFB were included, with some patients also undergoing transbronchial cryobiopsy. Patients without pathology reports available were excluded. Results The combination of EBUS-MFB and EBUS-TBNA had the highest percentage of diagnostic results both in the overall cohort (34.4%) and in patients who did not undergo transbronchial cryobiopsy (46.2%). EBUS-MFB alone yielded more diagnostic results compared to EBUS-TBNA. Transbronchial cryobiopsy was the sampling method with the highest percentage of diagnostic results in the cryobiopsy group (64.5%). Statistical analysis revealed a significant difference in diagnostic yield between EBUS-MFB and EBUS-TBNA (P<0.001), with EBUS-MFB showing a higher diagnostic yield overall. EBUS-MFB had a significantly higher diagnostic yield than EBUS-TBNA in benign cases, in patients diagnosed with sarcoidosis, but not in malignant disease. Conclusions Our study suggests that combining EBUS-MFB with EBUS-TBNA can improve the diagnostic yield, particularly in benign cases and sarcoidosis. These findings support the potential superiority of adding EBUS-MFB over EBUS-TBNA alone and highlight the need for further randomized control trials to validate these results. The retrospective nature of this study and certain limitations, such as the lack of adequate longer-term follow-up, selection and operator biases, and the absence of rapid on-site evaluation (ROSE) in some cases, should be considered when interpreting the results. Nonetheless, this study contributes to the growing evidence for the utility of EBUS-MFB in improving the diagnostic yield of EBUS procedures in specific clinical scenarios.
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Affiliation(s)
| | - Oshioke Esivue
- Department of Pulmonary and Critical Care, Albert Einstein Medical Center, Philadelphia, PA, USA
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Brown MV, Lavrencic K, Badiei A, Jersmann H, Fon A, Chang S, Nguyen P. First Asia-Pacific experience of trans-bronchial core biopsy with a Franseen needle. J Thorac Dis 2023; 15:3273-3284. [PMID: 37426168 PMCID: PMC10323551 DOI: 10.21037/jtd-22-1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/21/2023] [Indexed: 07/11/2023]
Abstract
Background Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the standard for evaluating mediastinal and hilar lesions. EBUS-TBNA is limited by small volume of material obtained for immunohistochemistry (IHC) and ancillary studies important for oncological therapies. The Franseen AcquireTM needle is designed for EBUS-transbronchial needle core biopsy (TBNB) allowing larger core sizes with evidence in gastroenterology literature but little in pulmonology. This study reports the first Asia-Pacific experience of EBUS-TBNB and adequacy of samples for diagnosis and ancillary studies. Methods A retrospective cohort study of EBUS-TBNB at the Royal Adelaide Hospital was conducted between December 2019 and May 2021. Diagnostic rate, adequacy for ancillary studies and complications were evaluated. Samples were flushed into formalin for histological processing with no rapid on-site cytological evaluation (ROSE). For suspected lymphoma, samples were flushed into HANKS for flow cytometry. Cases performed with the Olympus VizishotTM during the same 18-month were similarly analysed. Results One hundred and eighty-nine patients were sampled with the AcquireTM needle. Diagnostic rate was 174/189 (92.1%). Where reported [146/189 (77.2%)], average core aggregate sample size was 13.4 mm × 10.7 mm × 1.7 mm. For non-small cell lung cancer (NSCLC) cases, 45/49 (91.8%) had adequate tissue for programmed cell death-ligand 1 (PD-L1). 32/35 (91.4%) adenocarcinoma cases had sufficient tissue for ancillary studies. There was one false negative malignant lymph node at the first AcquireTM procedure. There were no major complications. One hundred and one patients were sampled with the VizishotTM needle. Diagnostic rate was 86/101 (85.1%) with only 25/101 (24.8%) having reported tissue cores (P<0.0001 of VizishotTM) with the remaining samples processed via cell block. Conclusions AcquireTM EBUS-TBNB diagnostic rate is comparable to historical data with >90% of cases having sufficient core material for ancillary studies. There appears to be a role for the AcquireTM alongside the standard of care for the work up of lymphadenopathy and particularly for lung cancer.
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Affiliation(s)
- Michael V. Brown
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Katherine Lavrencic
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Arash Badiei
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Hubertus Jersmann
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Andrew Fon
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Department of Respiratory and Sleep Medicine, Queen Elizabeth Hospital, Adelaide, Australia
| | | | - Phan Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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3
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de Ruiter QMB, Fontana JR, Pritchard WF, Mauda-Havakuk M, Bakhutashvili I, Esparza-Trujillo JA, Varble NA, Verstege M, Xu S, Seifabadi R, Browning RF, Wood BJ, Karanian JW. Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance. Transl Lung Cancer Res 2021; 10:3627-3644. [PMID: 34584862 PMCID: PMC8435394 DOI: 10.21037/tlcr-21-275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endobronchial navigation is performed in a variety of ways, none of which are meeting all the clinicians' needs required to reach diagnostic success in every patient. We sought to characterize precurved and steerable guiding sheaths (GS) in endobronchial targeting for lung biopsy using cone beam computed tomography (CBCT) based augmented fluoroscopy (AF) image guidance. METHODS Four precurved GS (EdgeTM 45, 90, 180, 180EW, Medtronic) and two steerable GS [6.5 F Destino Twist (DT), Oscor; 6 F Morph, BioCardia] were evaluated alone and in combination with an electromagnetic tracking (EM) guide and biopsy needles in three experimental phases: (I) bench model to assess GS deflection and perform biopsy simulations; (II) ex vivo swine lung comparing 2 steerable and 2 precurved GS; and (III) in vivo male swine lung to deliver a needle (n=2 swine) or to deliver a fiducial marker (n=2 swine) using 2 steerable GS. Ex vivo and in vivo image guidance was performed with either commercial or prototype AF image guidance software (Philips) based on either prior CT or procedural CBCT. Primary outcomes were GS delivery angle (θGS) and needle delivery angle (θN) in bench evaluation and needle delivery error (mm) (mean ± se) for ex vivo and in vivo studies. RESULTS The steerable DT had the largest range of GS delivery angles (θN: 0-114°) with either the 21 G or 19 G biopsy needle in the bench model. In ex vivo swine lung, needle delivery errors were 8.7±0.9 mm (precurved Edge 90), 5.4±1.9 mm (precurved Edge 180), 4.7±1.2 mm (steerable DT), and 5.6±2.4 mm (steerable Morph). In vivo, the needle delivery errors for the steerable GS were 6.0±1.0 mm (DT) and 15±7.0 mm (Morph). In vivo marker coil delivery was successful for both the steerable DT and morph GS. A case report demonstrated successful needle biopsy with the steerable DT. CONCLUSIONS Endobronchial needle delivery with AF guidance is feasible without a bronchoscope with steerable GS providing comparable or improved accuracy compared to precurved GS.
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Affiliation(s)
- Quirina M. B. de Ruiter
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Joseph R. Fontana
- Pulmonary Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - William F. Pritchard
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Michal Mauda-Havakuk
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Juan A. Esparza-Trujillo
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Nicole A. Varble
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Philips Research of North America, Cambridge, MA, USA
| | | | - Sheng Xu
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Reza Seifabadi
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Bradford J. Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Center for Cancer Research, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - John W. Karanian
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
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Song N, Yang L, Wang H, Jiang L, Zhao L, Colella S, Jagan N, Almeida FA, Wu L, Gu Y, He Y. Radial endobronchial ultrasound-assisted transbronchial needle aspiration for pulmonary peripheral lesions in the segmental bronchi adjacent to the central airway. Transl Lung Cancer Res 2021; 10:2625-2632. [PMID: 34295667 PMCID: PMC8264313 DOI: 10.21037/tlcr-21-490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
Background Tissue samples from lesions located in the 3rd to 5th segmental bronchi are challenging to obtain. In this retrospective study, we aimed to evaluate the diagnostic rate of pulmonary peripheral lesions located in the 3rd to 5th segmental bronchi, near the inner field of lung on the computed tomography (CT) image and outside the bronchus, using radial endobronchial ultrasound (REBUS) followed by transbronchial needle aspiration (TBNA). Methods This retrospective study enrolled patients whose preoperative CT examinations showed a lesion located in the segmental bronchi (3rd to 5th), yet adjacent to the inner field of lung on the CT image. REBUS followed by TBNA was used to acquire tissue samples from these lesions. A bronchoscope was used to reach the bronchi surrounding the lesion, and an ultrasound probe was used to determine the lesion's location. Then, the ultrasound probe was withdrawn, and puncture was performed at the location that was determined by ultrasound. The tissue specimens obtained were subjected to pathological examination. Results Nineteen patients were enrolled in this study including 15 males and 4 females with an average age of 55 years old. Of the enrollees, 8 patients (42.1%) were successfully diagnosed with samples obtained through TBNA, including 6 cases of lung cancer, 1 case of non-specific inflammation, and 1 case of cryptococcal infection. The diagnostic rate was 42.1%. No post-procedural complications were observed among the patients. There was no significant difference in nodule diameter between patients with a diagnostic sample and those in whom TBNA failed to provide a diagnosis (2.99±0.96 vs. 2.26±1.27 cm, P=0.20). Conclusions With the assistance of REBUS, TBNA can acquire sufficient samples to achieve a reasonably diagnostic rate for parenchymal lung lesions located near the inner field of lung on the CT image without intrabronchial invasion.
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Affiliation(s)
- Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Li Yang
- Department of Endoscopy Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao Wang
- School of Medicine, Tongji University, Shanghai, China.,Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Lishu Zhao
- School of Medicine, Tongji University, Shanghai, China.,Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Sara Colella
- Pulmonary Unit, "G. Mazzini" Hospital, Teramo, Italy
| | - Nikhil Jagan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Creighton University Medical Center, Omaha, NE, USA
| | | | - Liang Wu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ye Gu
- Department of Endoscopy Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yayi He
- School of Medicine, Tongji University, Shanghai, China.,Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
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Abstract
Convex probe endobronchial ultrasound (CP-EBUS) has been widely used in the lymph node staging and restaging of lung tumors and the diagnosis of mediastinal diseases. Recent years have seen continuous progress in this technology. For diagnosis, elastography technology can preliminarily distinguish between benign and malignant lesions, so that reduce the number of punctures. CP-EBUS can also be used as an endoscopic ultrasound (EUS) to guide needle aspirations of liver lesions, retroperitoneal lymph nodes and left adrenal gland (LAG) lesions sometimes. Some advances help diagnosing more accurately and effectively, such as the intranodal forceps biopsy (IFB), the new type of 22G needle, the rapid on-site evaluation (ROSE) and the cancer gene methylation, etc. In addition, special advances are being made in diagnosis using artificial intelligence (AI). For treatment, CP-EBUS has yielded novel research results when applied to transbronchial needle injection (TBNI) and radioactive seed implantation in clinical cases, and blocking of the cardiac plexus in animal studies. The next-generation CP-EBUS is also ready for use in the clinic and the technology will be improving continuously. Through this review, we hope to educate clinicians on the latest uses of CP-EBUS and open up further research ideas for readers interested in this technology.
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Affiliation(s)
- Jian Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Cen Wu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chuming Zhou
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Li
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
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6
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Xu C, Qin L, Lei W, Jiang J, Ni C, Huang J. The role of endobronchial ultrasound-guided transbronchial needle aspiration liquid-based cytology in the diagnosis of mediastinal lymphadenopathy. Diagn Cytopathol 2019; 48:316-321. [PMID: 31883315 PMCID: PMC7079241 DOI: 10.1002/dc.24374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, reliable technique for sampling mediastinal lymph nodes (LNs). Liquid-based cytology (LBC) is widely used for cervical cancer screening because it provides reliable and feasible results. The present study aimed to evaluate effectiveness of the combination of EBUS-TBNA and LBC in the diagnosis of mediastinal lymphadenopathy. METHODS A total of 602 LNs that were retrospectively analyzed were sampled in 442 patients who underwent EBUS-TBNA between January 2014 and December 2016. The histopathological result of TBNA tissue or cell blocks was considered as the gold standard to evaluate diagnostic utility of LBC and conventional smears (CS) for the diagnosis of mediastinal lymphadenopathy. RESULTS Of the 602 LNs, 265 were mediastinal LN metastases from lung cancer, four were lymphoma, and 333 were benign. The sensitivity of LBC and CS in the diagnosis of mediastinal LN metastases from lung cancer was 72.8% and 63%, respectively, and the specificity was 98.5% and 97%, respectively. The positive predictive values for LBC and CS were 97.5% and 94.4%, respectively, whereas the negative predictive values were 82.2% and 76.9%, respectively. The accuracy of LBC and CS was 88% and 83.7%, respectively. The diagnostic value of LBC was significantly higher than that of CS (P = .001). CONCLUSIONS The combination of EBUS-TBNA and LBC is a highly reliable and feasible procedure that optimizes diagnostic utility for the diagnosis of lung cancer and mediastinal LN staging.
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Affiliation(s)
- Chuancai Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingyan Qin
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Lei
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junhong Jiang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chongjun Ni
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian'an Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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7
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Abstract
Endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) have changed the landscape of pulmonology. Mediastinal structures beyond the confines of airway walls are visualized in real-time with EBUS, leading to improved accuracy of tissue sampling and diagnostic yield. With the development of various needle sizes ranging from 25-G to 19-G, the sampling of lymph nodes is becoming easier and more commonplace. Yet, certain conditions such as sarcoidosis and lymphoma may still be difficult to diagnose via EBUS-TBNA. Furthermore, in the age of targeted therapy, there are more demands on EBUS-TBNA samples for molecular marker testing and next-generation sequencing. Here, we present a complementary methodology, EBUS-guided intranodal forceps biopsy (EBUS-IFB), for tissue acquisition that may help address these deficiencies. Specifically, we aim to propose indications, contraindications, outline approaches in performing IFB, and provide an overview of the data for this complementary technique.
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Affiliation(s)
- George Cheng
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, NC, USA
| | - Amit Mahajan
- Inova Cardiac and Thoracic Surgery, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Scott Oh
- Division of Pulmonary, Critical Care Medicine, UCLA Medical Center, Santa Monica, CA, USA
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care Medicine, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Alexander Chen
- Division of Pulmonary, Critical Care Medicine, Washington University Hospital, St Louis, MO, USA
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8
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Zhong R, Zheng X, Teng J, Han B. Application of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal lymphangioma. Ann Transl Med 2019; 7:450. [PMID: 31700886 DOI: 10.21037/atm.2019.08.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Mediastinal lymphangioma is a rare lymphatic malformation, and the standard treatment strategy is surgical dissection. Endobronchial ultrasound-guided transbronchial needle aspiration has good diagnostic abilities for paratracheal, mediastinal, and hilar lymph node lesions. Endoscopic ultrasound is a new technique which can be used for the treatment of mediastinal lymphangioma to reduce the incidence of surgical-related complications. This study was designed to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the treatment of mediastinal lymphangioma. Methods Retrospective analysis was carried out on nine patients with mediastinal lymphangioma who underwent endoscopic ultrasound-guided fine-needle aspiration from 2010 to 2018 in Shanghai Chest Hospital. Results No patients suffered serious complication. The amount of fluid aspirated was 50-205 mL. The disease was stable over a period of 9 months to 2 years. Conclusions Endobronchial ultrasound-guided transbronchial needle aspiration could be an effective method for the treatment of mediastinal lymphangioma with a little trauma compared with surgical dissection, which may have significant therapeutic effects.
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Affiliation(s)
- Runbo Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiaoxuan Zheng
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Jiajun Teng
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Hashimi H, Cooke DT, David EA, Brown LM. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of non-small cell lung cancer. J Vis Surg 2018; 4:37. [PMID: 29552519 DOI: 10.21037/jovs.2018.01.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/10/2018] [Indexed: 11/06/2022]
Abstract
Accurate staging for non-small cell lung cancer (NSCLC) is essential to guide therapy. While computed tomography (CT) and positron emission tomography (PET) scan can indicate whether mediastinal lymphadenopathy is present, histologic confirmation is required to complete the staging evaluation. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique associated with similar diagnostic yield and improved postoperative pain and complication rates compared to mediastinoscopy. We share the surgical technique for EBUS-TBNA based on our experience. An 81-year-old man underwent EBUS-TBNA for concurrent tissue diagnosis and mediastinal staging of a hypermetabolic left lower lobe mass and subcarinal lymph node. Our patient had no perioperative complications and was discharged home on the same day. Histologic evaluation demonstrated squamous cell carcinoma in the left lower lobe and subcarinal lymph node. EBUS-TBNA provides histologic confirmation of suspicious mediastinal lymph nodes seen on imaging. Clinicians should consider EBUS-TBNA as a mediastinal staging modality for patients with NSCLC.
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Affiliation(s)
- Habiba Hashimi
- Section of General Thoracic Surgery, Department of General Surgery, University of California Davis Health, Sacramento, CA, USA
| | - David T Cooke
- Section of General Thoracic Surgery, Department of General Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Elizabeth A David
- Section of General Thoracic Surgery, Department of General Surgery, University of California Davis Health, Sacramento, CA, USA.,Heart Lung Vascular Center, David Grant Medical Center, Travis AFB, CA, USA
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of General Surgery, University of California Davis Health, Sacramento, CA, USA
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10
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Righi L, Franzi F, Montarolo F, Gatti G, Bongiovanni M, Sessa F, La Rosa S. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-from morphology to molecular testing. J Thorac Dis 2017; 9:S395-S404. [PMID: 28603651 PMCID: PMC5459867 DOI: 10.21037/jtd.2017.03.158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/14/2017] [Indexed: 12/25/2022]
Abstract
In recent years, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as an innovative technique for diagnosis and staging of lung cancer and has been successfully introduced into daily clinical practice with several advantages including minimally invasive approach, safe, cost-effective, real time image guidance, broad sampling capability, and rapid on-site evaluation (ROSE). Both cytological and histological approach could be useful to have material for diagnosis, immunohistochemical and molecular analyses which may be very important for targeted therapy with successful rate ranging from 89% to 98%. The utility of ROSE during EBUS-TBNA has been matter of debate. Indeed, although some evidence concluded that ROSE does not increase the diagnostic efficacy of EBUS-TBNA, other demonstrated that it improves the diagnostic yield of the procedure up to 30%, allows to avoid repetition of additional diagnostic procedures and reduces risk of complications. Furthermore the sample preparation by cytopathologist is optimized with the aid of direct macroscopic inspection, optimal smearing techniques, and triage of the sample permitting to obtain adequate tissue for diagnosis, ancillary techniques and molecular testing, when needed. Some pathological issues on EBUS-TBNA are reviewed and discussed with particular focus on ROSE and molecular testing.
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Affiliation(s)
- Luisella Righi
- Pathology Unit, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | | | - Francesca Montarolo
- Pathology Unit, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Gaia Gatti
- Pathology Unit, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Fausto Sessa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Stefano La Rosa
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
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11
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Rosso L, Ferrero S, Mendogni P, Bonaparte E, Carrinola R, Palleschi A, Righi I, Montoli M, Damarco F, Tosi D. Ten-year experience with endobronchial ultrasound-guided transbronchial needle aspiration: single center results in mediastinal diagnostic and staging. J Thorac Dis 2017; 9:S363-S369. [PMID: 28603646 DOI: 10.21037/jtd.2017.03.115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Endobronchial ultrasonography with transbronchial needle aspiration (EBUS-TBNA) is recognized as an accurate and minimal invasive procedure for diagnosis and staging of lung cancer and lymph nodal malignancies. EBUS is recommended as the first choice procedure for mediastinal staging in lung cancer in international guidelines. METHODS A retrospective evaluation was performed on single center experience with EBUS-TBNA in our thoracic surgery department in a 10-year time frame. Main indication for the procedure was suspected non-lymphomatous malignancy in intrathoracic lymph-nodes on computed tomography (CT) or positron emission tomography (PET) scan. All procedures were performed under conscious sedation in a day-hospital setting. All the aspirated specimens were obtained with a 22-gauge needle and were fixed in 10% formalin and paraffin embedded. Sections of 3 micron in thickness were cut and hematoxylin-eosin stained. RESULTS From October 2005 to August 2016, 496 patients were submitted to EBUS-TBNA. Number of nodal stations punctured was 592 with a mean of 2.25 punctures per patient. Diagnosis of malignancy was obtained in 291 patients (58.6%). In 25 cases a nodal metastasis from an extrathoracic primary tumor was diagnosed. Sensitivity, specificity and diagnostic accuracy were 95%, 100% and 96% respectively. Negative predictive value was 90% and positive predictive value (PPV) was 100%. When molecular tests were requested, mutational analysis was successfully performed on cell block derived material in 55 out of 56 cases (98.2%), and fluorescence in situ hybridization (FISH) analysis in 26 out of 27 cases (96.2%). CONCLUSIONS EBUS-TBNA in our setting was an accurate and safe tool to diagnose non-lymphomatous nodal malignancies. Interestingly, in our series EBUS-TBNA has demonstrated to yield sufficient tissue for molecular analysis.
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Affiliation(s)
- Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Bonaparte
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosaria Carrinola
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Montoli
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Damarco
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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12
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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. Clin Respir J 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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13
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Liu QH, Arias S, Wang KP. International association for the study of lung cancer map, Wang lymph node map and rapid on-site evaluation in transbronchial needle aspiration. J Thorac Dis 2016; 8:E869-E874. [PMID: 27747023 DOI: 10.21037/jtd.2016.08.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The invaluable role of transbronchial needle aspiration (TBNA) in the diagnosis and staging of mediastinal adenopathy and lung cancer has been well established. Different lymph nodes regional nomenclatures and maps had been described over the years. The international association for the study of lung cancer (IASLC) and Wang's maps complement each other benefiting patients with lung cancer. In this article we briefly reviewed the roles of IALSC, Wang's maps and ROSE in TBNA.
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Affiliation(s)
- Qing-Hua Liu
- Department of Respiratory medicine, Shandong Provincial Hospital affiliated to Shandong University, Jinan 250041, China
| | - Sixto Arias
- Interventional Pulmonology, Division of Pulmonary Medicine and Critical Care, Johns Hopkins University, School of Medicine, Baltimore, MD 21287, USA
| | - Ko-Pen Wang
- Interventional Pulmonology, Division of Pulmonary Medicine and Critical Care, Johns Hopkins University, School of Medicine, Baltimore, MD 21287, USA
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Mallya V, Kumar SP, Meganathan P, Shivkumar S, Mehta R. The utility of ROSE (rapid on-site evaluation) in endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA): Is the picture rosy? J Cytol 2016; 32:230-3. [PMID: 26811569 PMCID: PMC4707783 DOI: 10.4103/0970-9371.171226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mediastinal lymphadenopathy (ML) presents a diagnostic challenge. The technique to sample the lymph nodes has evolved from conventional "blind" transbronchial needle aspiration (TBNA) to the present day endobronchial ultrasound (EBUS)-guided procedure that improves the accuracy of sampling. OBJECTIVE This study was undertaken to evaluate the utility of "rapid on-site evaluation" (ROSE) in EBUS-guided TBNA (EBUS-TBNA) for the diagnosis of ML. PATIENTS AND METHODS This prospective study included 80 patients who underwent EBUS-TBNA for computed tomography/positron emission tomography (CT/PET) diagnosed ML over a 4-month period at a single tertiary care center. All 80 of these patients underwent histopathological evaluation (HPE) in addition to cytology. Three out of these 80 (3.7%) patients were excluded in view of inadequate material on EBUS-TBNA. After the sampling of nodes was done, the slides were stained with rapid hematoxylin and eosin (H&E) and then on-site evaluation was done. The tissue derived was also processed for HPE in all cases. RESULTS ROSE revealed granuloma in 27 patients and malignancy in 14 patients, and the remaining patients showed nonspecific inflammation. Concomitant histopathology revealed granuloma in 34 patients and malignancy in 14 patients. Considering HPE as gold standard, the overall sensitivity and specificity of EBUS-TBNA for diagnosis were 85.4% and 89.6%, respectively. For malignancy alone, the sensitivity and specificity were 100% and 98.4%, respectively. CONCLUSION This novel approach is safe, has good diagnostic yield, and has an excellent potential in assisting safe and accurate diagnostic interventional bronchoscope.
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Affiliation(s)
- Varuna Mallya
- Department of Pathology, Dr. BR Ambedkar Medical College, Bengaluru, Karnataka, India
| | - Sandeep P Kumar
- Department of Pathology, Dr. BR Ambedkar Medical College, Bengaluru, Karnataka, India
| | - Prabhu Meganathan
- Department of Pathology, Apollo Hospital, Bengaluru, Karnataka, India
| | - Swarna Shivkumar
- Department of Pathology, Apollo Hospital, Bengaluru, Karnataka, India
| | - Ravindra Mehta
- Department of Pulmonology, Apollo Hospital, Bengaluru, Karnataka, India
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15
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Abstract
Accurate determination of the diagnosis and the stage of lung cancer play a critical role to ensure that patients are provided the optimal treatment. However, the process is usually beyond complex. Early studies have suggested lymph nodes (LNs) >1.0 cm in size on computed tomography (CT) are considered as metastatic nodes, while the sensitivity of this criterion is not satisfied. Subsequently, positron emission tomography-computed tomography (PET-CT) was shown to be superior to CT alone on assessment of nodal involvement and was widely used to estimate suitability for resection with curative intent, but the dependability also remains controversial. Furthermore, transbronchial needle aspiration (TBNA) with and without endobronchial ultrasound (EBUS), as a well-accepted minimally invasive approach for LN biopsy, has been documented as an efficient tool in evaluation of CT and PET-CT negative LNs. Additionally, radiographic features including ground-glass/solid nodules ratio, referring as imaging biomarker, were indicated to be correlated with metastasis. Hence, we highlight the importance of comprehensive estimation of mediastinal and hilar LNs, and we suggested the judgment of LNs by radiographic tools alone might not be reliable and TBNA is indispensable in certain circumstances.
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Affiliation(s)
- Yang Xia
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Bin Zhang
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Hao Zhang
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Wen Li
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Ko-Pen Wang
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Huahao Shen
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
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16
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Jin XR, Ye M, Cai ZZ, Li YP, Ye CE, He QX, Wang KP, Chen CS. Standardized transbronchial needle aspiration procedure for intrathoracic lymph node staging of non-small cell lung cancer. J Thorac Dis 2016; 7:S266-71. [PMID: 26807273 DOI: 10.3978/j.issn.2072-1439.2015.11.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Thoracic lymph node (LN) metastasis is the determining factor for NSCLC staging. However, enlargement in thoracic LNs, which can be detected by chest computed tomography (CT), may not be adequate for NSCLC staging. This study aimed to investigate the effectiveness of a new transbronchial needle aspiration (TBNA) procedure to improve the sensitivity and accuracy of lung cancer diagnosis and staging. METHODS A standardized TBNA procedure was performed on enlarged and non-enlarged LNs in the order of N3 to N1 station according to Wang's LN map. The status of LN metastasis determined by the standardized TBNA procedure was compared with the results from CT scan. RESULTS The TBNA biopsy revealed that 21.43% of non-enlarged LNs were malignant. Compared with chest CT, the standardized TBNA procedure improved the accuracy of LN metastasis staging and discovered skip LN metastasis. CONCLUSIONS The standardized TBNA procedure of this study may be recommended to be used as a routine TBNA procedure, in which LNs should be biopsied in the order of N3 to N1 station and both enlarged and non-enlarged LNs should be included to improve the accuracy of lung cancer staging.
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Affiliation(s)
- Xu-Ru Jin
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
| | - Min Ye
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
| | - Zhen-Zhen Cai
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
| | - Yu-Ping Li
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
| | - Cai-Er Ye
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
| | - Qiu-Xiang He
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
| | - Ko-Pen Wang
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
| | - Cheng-Shui Chen
- 1 Department of Respiratory and Critical Care Medicine, 2 Department of radiology, 3 Department of pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China ; 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21211, USA
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17
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Abstract
Peripheral lung nodule evaluation represents a clinical challenge. Given that many nodules will be incidentally found with lung cancer screening following the publication of the National Lung Screening Trial (NLST), the goal is to find an accurate, safe and minimally-invasive diagnostic modality to biopsy the concerning lesions. Unfortunately, conventional bronchoscopic techniques provide a poor diagnostic yield of 18-62%. In recent years advances in technology have led to the introduction of electromagnetic navigational bronchoscopy (ENB) as a tool to guide sampling of peripheral lung nodules. The same principle has also recently been expanded and applied to the transthoracic needle biopsy, referred to as electromagnetic transthoracic needle aspiration (E-TTNA). An improved diagnostic yield has afforded this technology a recommendation by the 2013 3(rd) Edition ACCP Guidelines for the Diagnosis and Management of Lung Cancer which state that "in patients with peripheral lung lesions difficult to reach with conventional bronchoscopy, ENB is recommended if the equipment and the expertise are available (Grade 1C)". In this review we will discuss the technology, devices that are available, techniques and protocols, diagnostic yield, safety, cost effectiveness and more.
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Affiliation(s)
- Sixto Arias
- 1 University of Miami, Interventional Pulmonology, Assistant Professor of Medicine, Pulmonary and Critical Care Medicine; 2 Johns Hopkins University, Interventional Pulmonology, Assistant Professor of Medicine, Pulmonary and Critical Care Medicine; 3 Division of Pulmonary and Critical Care, Assistant Professor of Medicine, Interventional Pulmonology, Northwestern University, Chicago, IL, USA
| | - Lonny Yarmus
- 1 University of Miami, Interventional Pulmonology, Assistant Professor of Medicine, Pulmonary and Critical Care Medicine; 2 Johns Hopkins University, Interventional Pulmonology, Assistant Professor of Medicine, Pulmonary and Critical Care Medicine; 3 Division of Pulmonary and Critical Care, Assistant Professor of Medicine, Interventional Pulmonology, Northwestern University, Chicago, IL, USA
| | - A Christine Argento
- 1 University of Miami, Interventional Pulmonology, Assistant Professor of Medicine, Pulmonary and Critical Care Medicine; 2 Johns Hopkins University, Interventional Pulmonology, Assistant Professor of Medicine, Pulmonary and Critical Care Medicine; 3 Division of Pulmonary and Critical Care, Assistant Professor of Medicine, Interventional Pulmonology, Northwestern University, Chicago, IL, USA
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18
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Lei W, Zeng DX, Chen T, Jiang JH, Wang CG, Zhu YH, Huang JA. FDG PET-CT combined with TBNA for the diagnosis of atypical relapsing polychondritis: report of 2 cases and a literature review. J Thorac Dis 2014; 6:1285-92. [PMID: 25276371 DOI: 10.3978/j.issn.2072-1439.2014.08.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/31/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To explore the value of (18)F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) combined with transbronchial needle aspiration (TBNA) in diagnosing atypical relapsing polychondritis (RP). METHODS Data from two patients with atypical RP, which had been diagnosed in our hospital using FDG PET-CT combined with TBNA, were retrospectively analyzed. A review of the relevant literature was also performed. RESULTS Consistent with the previously reported 20 cases of RP that had been diagnosed using FDG PET-CT, the two patients in the present study showed the involvement of multiple organs, including the nose, throat, trachea, bronchi, costicartilage and joint cartilages, and increased FDG uptake was found in these areas. The mean value of SUVmax was 5.14. PET-CT revealed that 86.4% of the patients with RP had airway involvement. TBNA technique was used for biopsy of the hypermetabolic lesions, and pathologic examinations confirmed the diagnosis of RP. The time to diagnosis in these two patients and the 20 cases reported previously was about 6.9 months, significantly shorter than the average diagnosis time (20 months). CONCLUSIONS FDG PET-CT has several advantages for diagnosing RP, especially atypical RP. TBNA is a minimally invasive and safe technique for obtaining airway cartilage. Combining PET-CT with TBNA may play an important role in shortening the time to diagnosis in patients with RP involvement of airway.
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Affiliation(s)
- Wei Lei
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Da-Xiong Zeng
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Tao Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jun-Hong Jiang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chang-Guo Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ye-Han Zhu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jian-An Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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19
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Jiang J, Browning R, Lechtzin N, Huang J, Terry P, Wang KP. TBNA with and without EBUS: a comparative efficacy study for the diagnosis and staging of lung cancer. J Thorac Dis 2014; 6:416-20. [PMID: 24822097 DOI: 10.3978/j.issn.2072-1439.2014.03.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 03/17/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Conventional transbronchial needle aspiration (TBNA) has been around for over 30 years with sensitivities approaching 70-90%. Recent development of endobronchial ultrasound (EBUS) TBNA demonstrated even higher sensitivities among experts. However EBUS-TBNA is more costly and less available worldwide than conventional TBNA. A comparison study to determine the efficacy of TBNA with and without EBUS in the diagnosis and staging of lung cancer is described. METHODS A total of 287 patients with mediastinal and hilar lymphadenopathy presenting for diagnosis and/or staging of lung cancer at enrolling institutions were included. Equal numbers of punctures were performed at the target lymph node stations using conventional TBNA techniques followed by EBUS-TBNA at the same sites. Patients and puncture sites that were biopsied by both methods and were positive for lung cancer were compared to establish efficacy of each technique on the same patients. RESULTS In 253 patients at least one pair of specimens were obtained by conventional TBNA and EBUS-TBNA. In 83 of these patients malignancy was diagnosed. Among the 83 patients with a diagnosis of a malignancy there was no significant difference in the diagnostic yield of conventional TBNA versus EBUS-TBNA. When comparing diagnosis of malignancy for each lymph node sampled, there were a significantly greater number of positive (diagnostic for malignancy) lymph nodes sampled by EBUS-TBNA. CONCLUSIONS Recommendations for current practice depend on individual centers and bronchoscopist comfort level with TBNA (with or without EBUS). In our study, no significant difference was seen between the techniques for the diagnosis and staging of individual patients.
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Affiliation(s)
- Junhong Jiang
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China ; 2 Division of Interventional Pulmonology, Walter Reed National Military Medical Center, Bethesda, MD, USA ; 3 Department of Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Robert Browning
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China ; 2 Division of Interventional Pulmonology, Walter Reed National Military Medical Center, Bethesda, MD, USA ; 3 Department of Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Noah Lechtzin
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China ; 2 Division of Interventional Pulmonology, Walter Reed National Military Medical Center, Bethesda, MD, USA ; 3 Department of Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jianan Huang
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China ; 2 Division of Interventional Pulmonology, Walter Reed National Military Medical Center, Bethesda, MD, USA ; 3 Department of Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Peter Terry
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China ; 2 Division of Interventional Pulmonology, Walter Reed National Military Medical Center, Bethesda, MD, USA ; 3 Department of Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ko Pen Wang
- 1 Department of Respiratory, the First Affiliated Hospital of Soochow University, Suzhou 215006, China ; 2 Division of Interventional Pulmonology, Walter Reed National Military Medical Center, Bethesda, MD, USA ; 3 Department of Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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