Endobronchial Ultrasound Transbronchial Needle Aspiration in Mediastinal and Hilar Lymphadenopathies
ABSTRACT Endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) is a relatively noninvasive technique that allows sampling of mediastinal and hilar lymph nodes or masses under real-time and direct visualization, overcoming some of the problems associated with mediastinoscopy and blind TBNA. The goal of this study was to evaluate the yield of this technique in patients with and without malignant disease in a newly started EBUS program involving physicians not previously fully trained in interventional pulmonology.
Between March 2010 and July 2011, 43 patients with enlarged lymph nodes (>1 cm on short axis) on chest computed tomography who underwent EBUS-TBNA were included in the study. Nondiagnostic results were confirmed with mediastinoscopy. The sensitivity, specificity, positive predictive value and negative predictive value of the technique were assessed.
Among the 43 patients who underwent EBUS-TBNA, a correct diagnosis was made in 39 of the 43 patients (91%). The sensitivity, specificity, positive predictive value, and negative predictive values were 89%, 100%, 100%, and 67%, respectively. The success rate, complication rate, and 30-day mortality were 91%, 0%, and 0%, respectively.
EBUS-TBNA is a safe and effective approach with high diagnostic yield and minimal complications for diagnosing and staging of mediastinal/hilar lymph nodes. Satisfactory results can be obtained immediately by pulmonologists experienced in conventional bronchoscopy with the provision of additional training on the technique.
- [Show abstract] [Hide abstract]
ABSTRACT: We reviewed the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound guided fine needle aspiration (EUS-FNA) in the pretherapeutic assessment of patients with proven or suspected lung cancer. EUS-FNA and EBUS-TBNA have been shown to have a good diagnostic accuracy in the diagnosis and staging of lung cancer. In the future, these techniques in combination with positron emission tomography/computed tomographic may replace surgical staging in patients with suspected and proven lung cancer, but until then surgical staging remains the gold standard for adequate preoperative evaluation.01/2014; 3(4):205-212. DOI:10.4103/2303-9027.144510
- [Show abstract] [Hide abstract]
ABSTRACT: Background EUS is an operator-dependent procedure and requires more technical and cognitive skills than a routine endoscopic procedure. The learning curve for the staging of gastric cancer, however, has not been evaluated. Objective To evaluate the threshold number of EUS examinations for gastric cancer T staging. Design Retrospective study. Setting University-affiliated tertiary care hospital in the Republic of Korea. Patients Four trainees with no previous EUS experience. Intervention Analyzing performance of EUS trainees in gastric cancer T staging by using cumulative sum (CUSUM) analysis. Main Outcome Measurements CUSUM plot and a minimal number of procedures for reaching a plateau. Results A total of 553 initial EUS examinations for treatment-naïve gastric cancers, performed by trainees, were enrolled in the study. The final T stage was determined by experts by using EUS in 332 gastric cancer cases, whereas the T stage of the other 221 lesions was determined by trainees by using EUS. The accuracy of EUS examinations performed by trainees and experts was 72.6% and 84.3%, respectively. The number of EUS examinations required to reach the first plateau in each trainee was 20, 41, 60, and 65. Limitations Retrospective study with a relatively small number of trainees. Conclusion The CUSUM scores of all of 4 trainees in the study reached a plateau by the 65th examination.Gastrointestinal Endoscopy 10/2014; 81(4). DOI:10.1016/j.gie.2014.08.024 · 4.90 Impact Factor