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The role of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of hilar and mediastinal lesions

Egyptian Journal of Bronchology volume 13, pages 644–653 (2019)Cite this article

Abstract

Background

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been recently introduced as a new technique for sampling the hilar/ mediastinal lesions [lymph node (LN) enlargement or masses] with a potential to improve the diagnostic yield as it allows direct visualization of lesion beyond the tracheobronchial wall allowing real-time sampling. EBUS-TBNA diagnostic yield has been satisfactory for both benign and malignant lesions.

Aim

To evaluate the utility of convex probe EBUS-TBNA in the diagnosis of hilar and mediastinal lesions (LN enlargement or masses).

Patients and methods

This is a prospective study in which EBUS-guided TBNA via a real-time ultrasound bronchoscope was used to diagnose 25 patients with mediastinal or hilar LN enlargement or masses.

Results

EBUS-guided TBNA was performed on 15 patients with enlarged mediastinal/hilar LNs and 11 patients with mediastinal masses, achieving specific diagnosis in 73.3% (11/15) and 81.8% (9/11), respectively. The overall diagnostic yield of EBUS-TBNA was 76% (19/25). Overall sensitivity was 82.6%, specificity 100%, positive predictive value 100%, and negative predictive value 33.33%. EBUS-TBNA procedure had no complications in 76% of cases.

Conclusion

EBUS-TBNA is a minimally invasive, safe, yet still underutilized diagnostic technique with adequate diagnostic yield. Its nationwide application in the field of diagnostic bronchoscopy should be encouraged.

References

  1. Pillot G, Siegel BA, Govindan R. Prognostic value of fluorodeoxyglucose positron emission tomography in non-small-cell lung cancer: a review. J Thorac Oncol 2006; 1:152–159.

    Article  Google Scholar 

  2. Lemaire A, Nikolic I, Petersen T. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 2006; 82:1185–1189.

    Article  Google Scholar 

  3. Navani N, Spiro SG, Janes SM. Mediastinal staging of NSCLC with endoscopic and endobronchial ultrasound. Nat Rev Clin Oncol 2009; 6:278–286.

    Article  Google Scholar 

  4. Whitson BA, Groth SS, Maddaus MA. Surgical assessment and intraoperative management of mediastinal lymph nodes in non-small-cell lung cancer. Ann Thorac Surg 2007; 84:1059–1065.

    Article  Google Scholar 

  5. Navani N, Nankivell M, Nadarajan P. The learning curve for EBUS-TBNA. Thorax 2011; 66:352–353.

    Article  Google Scholar 

  6. Tremblay A, Stather DR, Maceachern P, Khalil M, Field SK. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest 2009; 136:340–346.

    Article  Google Scholar 

  7. Navani N, Booth HL, Kocjan G, Falzon M, Capitanio A, Brown JM, et al. Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bron-choscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis. Respirology 2011; 16:467–472.

    Article  Google Scholar 

  8. Hassan T, McLaughlin AM, O’Connell F, Gibbons N, Nicholson S, Keane J. EBUS-TBNA performs well in the diagnosis of isolated thoracic tuberculous lymphadenopathy. Am J Respir Crit Care Med 2011; 183:136–137.

    Article  Google Scholar 

  9. Jalil B, Yasufuku K, Maqbul Khan A. Uses, limitations, and complications of endobronchial ultrasound. Proc (Bayl Univ Med Cent) 2015; 28:325–330.

    Article  Google Scholar 

  10. Ernst A, Eberhardt R, Wahidi M, Becker HD, Herth FJ. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in (humans. Chest 2006; 129:734–737.

    Article  Google Scholar 

  11. Du Rand IA, Barber PV, Goldring J, Lewis RA, Mandal S, Munavvar M, et al. British Thoracic Society guidelines for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011; 66:iii1–iii21.

    PubMed  Google Scholar 

  12. Yasufuku K. EBUS-TBNA bronchoscopy. In: Ernst A, Herth JF, editors. Endobronchial ultrasound. An Atlas and practical guide. First edition. New York, NY: Springer Science and? Business Media LLC. 2009. pp. 119–141.

    Chapter  Google Scholar 

  13. Mehta AC, Wang KP, Turner JF. Teaching conventional transbronchial needle aspiration a continuum. Ann Am Thorac Soc 2013; 10:685–689.

    Article  Google Scholar 

  14. Safwat T, Khattab A, EL Haddad S, Mostafa Y, Korraa E, Madkour A, et al. Endobronchial ultrasound-directed transbronchial needle aspiration in diagnosis of mediastinal lesions: initial Egyptian experience. J Bronchology Interv Pulmonol 2009; 16:18–21.

    Article  Google Scholar 

  15. Ahmed MAI. Evaluation of endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA) in mediastinal lesions sampling. Mansoura: Doctor Degree Thesis, Mansoura University, Mansoura, Egypt 2018.

    Google Scholar 

  16. Vaidya PJ, Saha A, Kate AH, Pandey K, Chavhan VB, Leuppi JD. Diagnostic value of core biopsy histology and cytology sampling of mediastinal lymph nodes using 21-gauge EBUS-TBNA needle. J Cancer Res Ther 2016; 12:1172–1177.

    PubMed  Google Scholar 

  17. Ye T, Hu H, Luo X, Chen H. The role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis. BMC Cancer 2011; 11:100.

    Article  Google Scholar 

  18. Navani N, Nankivell M, Woolhouse L, Harrison R, Munavvar M, Oltmanns U, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extra thoracic malignancy. J Thorac Oncol 2011; 6:1505–1509.

    Article  Google Scholar 

  19. Kennedy MA, Jimenez CA, Bruzzi JF, Mhatre AD, Lei X, Giles FJ, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma. Thorax 2008; 63:360–365.

    Article  CAS  Google Scholar 

  20. Nakajima T, Yasufuku K, Fujiwara T, Chiyo M, Sekine Y, Shibuya K, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrapulmonary lesions. J Thorac Oncol 2008; 3:985–988.

    Article  Google Scholar 

  21. Verma A, Jeon K, Koh W, Suh G, Chung M, Kim H, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of central lung parenchymal lesions. Yonsei Med J. 2013; 54:672–678.

    Article  Google Scholar 

  22. ABU Baker MA. Endobronchial ultrasound in diagnosis of undiagnosed pulmonary sarcoidosis. Tanta: Master’s Degree Thesis, Tanta University, Tanta, Egypt; 2018.

    Google Scholar 

  23. Tournoy K, Bolly A, Aerts J, Pierard P, Pauw R, Leduc D, et al. The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis. Eur Respir J 2010; 35:1329–1335.

    Article  CAS  Google Scholar 

  24. Wahidi MM, Herth F, Yasufuku K, Shepherd RW, Yarmus L, Chawla M, et al. Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration. Chest 2016; 149:816–835.

    Article  Google Scholar 

  25. Bediwy AS, Zamzam K, Hantira M, El-Sharawy D, ElSaqa A, Zamzam Y. The value of rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions. Egypt J Bronchol 2017; 11:336–341.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Chest Diseases, Ain Shams University, Egypt

    Laila A. Helalah, Ashraf M. Madkour, Nevine M. A. Elfattah & Rehab M. Mohammed MD, PhD

  2. Department of Pathology, Ain Shams University, Egypt

    Ragaa A. Fawzy

  3. Department of Chest Diseases, Military Medical Academy, Egypt

    Ayman A. H. Farghaly

  4. Chest Department, Ministry of Health and Population, Chest Registrar, El-Abbassia Chest Hospital, Cairo, Egypt

    Asmaa M. A. Elasser

Authors
  1. Laila A. Helalah
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  2. Ashraf M. Madkour
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  3. Nevine M. A. Elfattah
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  4. Rehab M. Mohammed MD, PhD
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  5. Ayman A. H. Farghaly
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  6. Ragaa A. Fawzy
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  7. Asmaa M. A. Elasser
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Corresponding author

Correspondence to Rehab M. Mohammed MD, PhD.

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Helalah, L.A., Madkour, A.M., Elfattah, N.M.A. et al. The role of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of hilar and mediastinal lesions. Egypt J Bronchol 13, 644–653 (2019). https://doi.org/10.4103/ejb.ejb_57_19

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  • DOI: https://doi.org/10.4103/ejb.ejb_57_19

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