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Introduction: Intrathoracic lymph node metastasis from extrathoracic neoplasms are rare. Primary malignancies that metastasize to mediastinal-hilar lymph nodes are head and neck , carcinoma breast ,and genitourinary. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)/endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the preferred modality for mediastinal lymph node sampling. Methods: Fifty seven patients with extrathoracic malignancies with maximum standardized uptake value (SUVmax) of mediastinal-hilar lymph nodes greater than or equal to 2.5 were taken up for EBUS-TBNA. The histo-cytopathological results obtained from EBUS-TBNA were compared with SUVmax value and short-axis diameter of a lymph node as noted on EBUS. Results: Out of 74 sampled nodes, 49 (66.2%) were benign and 25 (33.8%) were malignant. The SUVmax range of benign nodes was 2.8� as compared to 3� of malignant nodes. The size range of malignant and benign nodes were 8� mm and 8� mm, respectively. The mean size of abnormal nodes (metastatic + granulomatous) was 17.5 (8� mm) and the mean SUVmax was 9.1 (3.4�), and it was a statistically significant difference when compared to reactive (normal) nodes. At SUVmax cut-off 7.5, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 78.5%, 81.2%, 84.6%, and 74.2%, respectively for detecting abnormal nodes. At 13 mm size cut-off, sensitivity, specificity, PPV, NPV were 75.5%, 65%, 75%, and 72%, respectively, for detecting abnormal nodes. Conclusion: The majority of mediastinal-hilar nodes with increased metabolic activity are benign in nature. Size and SUVmax are poor predictors of metastasis in tuberculosis endemic region. There should be a restrictive attitude toward invasive diagnostic testing for mediastinal-hilar nodes in extrathoracic malignancies.
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Objective:To investigate the application of transbronchial needle aspiration (TBNA) in the diagnosis of tuberculosis with mediastinal lymphadenopathy in children.Methods:A retrospective study was conducted on clinical data in 8 children of tuberculosis with mediastinal lymphadenopathy treated in the Center for Respiratory Intervention, Children′s Hospital Affiliated to Shandong University from March 2014 to July 2019.TBNA was performed after the mediastinal lymphadenopathy were diagnosed by chest enhanced CT and the final diagnosis was made.The diagnostic experience of TBNA was summarized.Results:Eight children with mediastinal lymphadenopathy included in this present study aged from 7 months to 8 years and 6 months (infants accounted for 75.0%), with a median age of 22.5 months.There were 3 males (37.5%) and 5 females (62.5%). The body mass was 8.5-39.0 kg, and the median body mass was 10.7 kg.The course of disease was 15-90 days, and the median number of days was 18.5 days.The clinical manifestations included cough in 8 cases, fever in 4 cases, wheezing in 1 case and laryngeal ringing in 1 case.Bronchoscopy and TBNA biopsy were performed.Cytology, etiology and pathology were examined after TBNA.A definite diagnosis could be made in 6 children, with a diagnosis rate of 75.0%.Among them, 4 cases were found with acid-fast bacilli in smear but pathological examination was negative; 1 case was pathologically conformed to the characteristics of tuberculosis infection but the smear was negative; the smear and pathology of 1 case were both suggestive of tuberculosis; 2 cases did not present etiological and histological evidence with TBNA.The diagnosis was made according to the positive acid-fast bacilli of alveolar lavage fluid smear.There were no complications during and after operation.Conclusions:TBNA is an important method to diagnose tuberculosis in children, which is effective, safe and has high clinical application value.
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Humans , Female , Aged , Bronchoscopy , Endoscopic Ultrasound-Guided Fine Needle Aspiration , UltrasonographyABSTRACT
Rationale: This case report presents the diagnosis and etiology of hilar/mediastinal lymphadenopathy in a male patient. Patient concerns: A 49-year-old man presented with fever and dyspnea after physical exertion. Diagnosis: The patient was diagnosed with melioidosis by cultivation of lymph node aspirate on blood agar using the VITEK 2 compact system. Interventions: The patient was treated with ceftazidime intravenously, combined with trimethoprim/sulfamethoxazole orally for 1 week. Once the patient was discharged, he began a 12-week course of trimethoprim/sulfamethoxazole. Outcomes: The patient recovered after treatment with ceftazidime and trimethoprim/sulfamethoxazole. Conclusions: Melioidosis is an infectious disease that mainly occurs in tropical regions. It can cause severe sepsis and pneumonia, and the infection in some patients may become chronic. Endobronchial ultrasound-transbronchial needle aspiration is a useful technique in the diagnosis of patients with hilar/mediastinal lymphadenopathy.
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Context: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and positron emission tomography/computed tomography (PET/CT) are the two most extensively used methods for the diagnosis and staging of lung cancer. Aims: The present study was designed to compare the diagnostic performance of EBUS-TBNA with that of PET/CT in patients with hilar and/or mediastinal lymphadenopathy. Settings and Design: We compared the accuracy of EBUS-TBNA with that of PET/CT in the diagnosis of hilar and/or mediastinal lymphadenopathy and evaluated the diagnostic utility of EBUS-TBNA in patients with PET/CT false-positive and false-negative findings. Methods: This study retrospectively analyzed 85 patients with hilar and/or mediastinal lymphadenopathy who underwent EBUS-TBNA and PET/CT between January 2014 and December 2017. The accuracy of EBUS-TBNA histopathology and cytopathology was evaluated and compared with PET/CT scan findings. Results: The diagnostic accuracy of EBUS-TBNA combined with PET/CT was significantly higher than that of the single diagnostic method (P < 0.001). Among PET/CT-negative lymph nodes, 4 of 9 (44.4%) malignant lymph nodes were identified by EBUS-TBNA. Among PET/CT-positive lymph nodes, 43 of 47 (91.5%) benign lymph nodes were diagnosed by EBUS-TBNA. Conclusions: EBUS-TBNA combined with PET/CT could effectively reduce false-positive and false-negative rates in the diagnosis of hilar and mediastinal lymphadenopathy, which might provide accurate staging, determine optimum therapeutic strategy and improve survival in patients with lung cancer.
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Background: Lung cancer is most frequently diagnosed major cancer in the world and the most common cause of cancer mortality worldwide. It comprises about 17% of the total new cancer cases in males and 23% of the total cancer deaths. The objectives of this study were to compare bronchial biopsy, BAL and TBNA in diagnosing lung malignancies and IHC wherever required.Methods: The study was conducted at Sher-i-Kashmir Institute of Medical Sciences Srinagar, India in the department of Pathology. It was a prospective study over a period of 1½ years from June 2015 to December 2016. All patients clinically/ radiologically suspected of lung malignancies who presented between June 2015 to December 2016 and underwent bronchial biopsy, BAL (washings) and TBNA were included in the study. The study included only those cases where BAL, TBNA and bronchial biopsy were done simultaneously.Results: Out of a total 117 clinically suspected cases of lung cancer, tumor was found in 103 cases (103/117) by biopsy, 51 cases by BAL (51/117) and 64 cases by TBNA (64/117). The total number of false positive cases and false negative cases by BAL were 6 and 58. Sensitivity of BAL was found to be 43.69% and specificity 57.14%. The total number of false positive cases and false negative cases by TBNA were 7 and 46. Sensitivity and specificity of TBNA was found to be 55.34% and 50.0%.Conclusions: Thus, in the present study yield of diagnosis was highest with the bronchoscopic biopsies and in maximum number of cases with a sensitivity of 88.034%, and specific histologic diagnosis was made by biopsies and IHC only. Though BAL and TBNA were inferior to bronchial biopsy in diagnosing lung malignancies but these were effective for peripheral lung malignancies and when the patient was at risk of haemorrhage.
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Rapid on-site evaluation(ROSE),an auxiliary sampling quality evaluation technology,can be used to evaluate the adequacy and diagnostic category of samples,judge the histological type of lung cancer,and optimize the gene type of lung cancer.Applying ROSE to endobronchial ultrasound-guided transbronchial needle aspiration of suspected lung cancer can improve the puncture success rate and diagnostic rate and reduce complications and puncture attempts.Rose performed via remote cytopathology technology or by trained respiratory specialists may become the future trends.
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Humans , Bronchoscopy , Cytodiagnosis/methods , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Lung Neoplasms/pathologyABSTRACT
BACKGROUND@#As a new technique developed in recent years, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has the advantages of simple operation, minimal invasive, high accuracy, safety and repeatability. It has become a new standard for lung cancer diagnosis and mediastinal staging. Because small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) have different biological characteristics and treatment methods, it is very important to diagnose and differentiate the types of lung cancer in the early stage of lung cancer for the staging, treatment and prognosis of lung cancer. This article evaluated the accuracy and sensitivity of EBUS-TBNA in the diagnosis of SCLC and NSCLC.@*METHODS@#From January 2012 to December 2018, the clinical data of 85 patients with SCLC and NSCLC who performed EBUS-TBNA in Xuan Wu Hospital CMU were retrospectively analyzed and the differences between the two groups were compared.@*RESULTS@#45 cases of SCLC were confirmed by immunohistochemistry and pathology. 42 cases of SCLC were diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 93.3% (42/45) and 100.0% (42/42), respectively. The positive rate of diagnosis was 48.9% (22/45) in 22 cases diagnosed by cytology, and 40 cases diagnosed by pathology, including 35 cases diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 87.5% (35/40) and 100.0% (35/35), respectively. The positive rate of diagnosis was 27.5% (11/40) in 11 cases diagnosed by cytology. The diagnostic sensitivity of EBUS-TBNA in SCLC group was significantly higher than that in NSCLC group (P<0.05).@*CONCLUSIONS@#EBUS-TBNA is more sensitive in the diagnosis of SCLC than NSCLC. As a minimally invasive technique, EBUS-TBNA can assist SCLC in early diagnosis and timely treatment.
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Objective@#To evaluate the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) in lymph node staging and resectability assessment of patients with non-small cell lung cancer (NSCLC).@*Methods@#The clinical data of 154 patients with NSCLC who underwent EBUS-TBNA from March 2015 to December 2018 were collected. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS-TBNA. EBUS-TBNA and CT were used for preoperative staging and resectability evaluation.@*Results@#The sensitivity, specificity and accuracy of EBUS-TBNA were 94.2%, 100.0% and 96.0%, respectively, while those of CT were 89.9%, 31.8% and 72.0%, respectively. The differences were statistically significant (P<0.05). The sensitivity, specificity and accuracy of EBUS-TBNA in lymph nodes with short diameter less than 15 mm were 92.4%, 100.0% and 96.0%, respectively, while those of CT were 80.7%, 34.8% and 60.1%, respectively, with statistical differences (P<0.05). The staging of 62 patients was changed, 27 cases were up-regulated and 35 cases were down-regulated. Among them, 32 cases had been changed to resectable. The evaluating resectability of EBUS-TBNA showed excellent consistency with that of pathological results (Kappa=0.95). The sensitivity and specificity were 100.0% and 97.2%, respectively.@*Conclusion@#EBUS-TBNA can systemically evaluate the metastatic status of NSCLC patients and improve the accuracy of preoperative lymph node staging and resectability assessment.
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BACKGROUND@#Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is well known as an important technique for diagnosis and staging of lung cancer. But a standard protocol to deal with patients who have a negative pathology result still needs to be defined. Herein, we describe the subsequent procedures of these patients in a single center.@*METHODS@#A total of 1,412 patients with clinical suspected lung cancer and mediastinal metastasis who underwent EBUS-TBNA were collected between September 2010 and December 2016. Among them, 51 patients with nonspecific pathology result were included and retrospectively analyzed.@*RESULTS@#The 51 patients were stratified into five groups by clinical characterize and follow-up procedures: (1) Diagnosed by other bronchoscopy procedures group (9 cases). Abnormalities of tracheobronchial tree were found during visual examination in the majority of patients (8 cases). Biopsy, endobronchial brushing, bronchoalveolar lavage, and transbronchial lung biopsy (TBLB) were used to get a specific diagnosis. (2) EBUS-TBNA re-biopsy group (11 cases). Patients in this group had normal mucosal appearance and airway lumen. Re-biopsy were performed on patients in this group. (3) Surgery group (6 cases). Patients underwent surgery after negative result of EBUS-TBNA. Five of them were confirmed with non-nodal metastasis after surgery. (4) Underwent other pathology diagnosis group (15 cases). patients in this group had other metastasis sites besides midiastinal lymph node. Computed tomography (CT)-guided fine-needle aspiration and lymph node biopsy were performed. (5) Follow-up group (10 cases). None invasive procedure was used in this group. The median follow up time was 38 months. One patient was diagnosed lymphoma during the follow up.@*CONCLUSIONS@#Diagnostic procedures should be chosen based on the clinical character in EBUS-TBNA negative patients with suspected lung cancer. Long time follow-up is very important in patients whose diagnosis is apparently unknown.
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Female , Humans , Male , Middle Aged , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Lung Neoplasms , Pathology , Lymphatic Metastasis , Mediastinum , Retrospective StudiesABSTRACT
()portant technique of endoscopic interventional diagnosis and treatment of lung disease. It plays an important role in the diagnosis of the nature of mediastinal, hilar and peripheral nodule lesions,as well as in the classification and staging of lung cancer. Compared with mediastinoscopy and thoracotomy,TBNA has the advantages of simple operation,less trauma,low cost and fewer complications. It has been widely used in adult respiratory diseases. However,because of their own characteristics,children have higher requirements on TBNA technology,equipment,anesthesia and so on,and the application of TBNA faces more challenges. With the continuous improvement of technology and the continuous exploration of pediatric respiratory interventional physicians,TBNA has been used more and more often in children,filling in the blank of routine diagnosis and treatment and bringing new diagnostic ideas and methods for children with mediastinal or hilar lesions.
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BACKGROUND@#Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an innovative technique for diagnosis and staging of lung cancer. But whether the procedure can provide enough tissue for the detection of gene mutations is still to be defined. Here we evaluated the efficacy of lung cancer diagnosis and gene analysis using samples obtain via EBUS-TBNA.@*METHODS@#Patients with suspected lung cancer and mediastinal lesions were referred for EBUS-TBNA. Diagnosis and sub-classifications were made by pathologists. Samples with non-squamous non small cell lung cancer sub type were tested for the EGFR and/or ALK mutations.@*RESULTS@#A total of 377 patients were included in this study. The median needle passes were 2.07. Lung cancer was diagnosed in 213 patients. The diagnosis accuracy for malignancy was 92%. Epidermal growth factor receptor (EGFR) mutations, anaplasticlymphoma kinase (ALK) fusion genes and double genes analysis were successfully preformed in 84 (90%), 105 (95%) and 79 (90%) patients. The number of needle passes and the diameters of lymph node were not associated with the efficacy of gene testing in univariate analysis. However, samples of adenocarcinoma sub type showed a tendency associated with higher genotyping efficacy.@*CONCLUSIONS@#Tissue samples obtained through EBUS-TBNA are sufficient for pathological diagnosis and genetic analysis of lung cancer. The pathology type of sample affected genotyping efficacy.
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Adult , Female , Humans , Male , Carcinoma, Non-Small-Cell Lung , Diagnosis , Genetics , Pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Feasibility Studies , Genotyping Techniques , Lung Neoplasms , Diagnosis , Genetics , PathologyABSTRACT
BACKGROUND@#Most of the patients with lung and (or) mediastinal occupying lesions are considered to be primary lung cancer clinically, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly useful operation to obtain the tissue sample and get definitive diagnosis of pathological tissues. In the EBUS-TBNA process, cytological rapid on-site evaluation (C-ROSE) is a useful technology. The purpose of our study is to discuss the value of C-ROSE in the diagnosis of lung cancer by EBUS-TBNA sampling.@*METHODS@#Retrospective analysis of 141 cases clinical data who were performed with EBUS-TBNA and suspected diagnosis primary lung cancer, which were found have mediastinal and (or) lung lesions (including the enlargement of the lymph nodes/mass) by computed tomography (CT). Among these patients, 81 patients were in the C-ROSE group and 60 patients were in the No C-ROSE group. The message of puncture and complication of EBUS-TBNA with or without C-ROSE were compared. At the same time, we analysis the sensitivity and specificity, positive predictive value, negative predictive value of C-ROSE combined with EBUS-TBNA in that of the diagnosis of lung cancer.@*RESULTS@#We found no statistical difference of the needle passes between C-ROSE group and No C-ROSE group. But in C-ROSE group, specimen qualified rate and diagnostic yields were signicantly higher than No C-ROSE group (98.77% vs 90.00%, 88.89% vs 75.00%, P<0.05), the incidence of complications in the C-ROSE group was signicantly lower than that in the No C-ROSE group (1.23% vs 11.67%, P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of C-ROSE combined with EBUS-TBNA in the diagnosis of lung cancer are 92.21%, 100.00%, 100.00% and 40.00%.@*CONCLUSIONS@#EBUS-TBNA combined with C-ROSE can improve the specimen qualified rate and diagnostic rate, also can reduce the complications thus worthy of further promotion.
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Female , Humans , Male , Middle Aged , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Methods , Lung Neoplasms , Pathology , Retrospective Studies , Time FactorsABSTRACT
ObjectiveEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) examination is a new bronchoscopy for early diagnosis and staging assessment of lung cancer, however it often makes patients scared and worried because of penetration and irritation brought by the operation. The article aimed to investigate the health education need of patients and analyze its influencing factors in order to provide evidence for pointed health education and successful examination.MethodsA self-designed questionnaire was used to investigate 100 patients with EBUS-TBNA at Thoracic Surgery Department in our hospital, from December 2016 to August 2017. Data were analyzed by SPSS 20.0 software.ResultsThe average score of health education need for patients undergoing EBUS-TBNA examination was (68.83±9.80). Single factor analysis showed there were differences in the scores of patients' ages, jobs, educational levels and medical insurance payment methods(P<0.05). Multiple linear regression analysis showed the influencing factors included educational level, age and medical insurance payment method, which could explain the mutation value 0.189. The average score of health education need was (13.84±1.30), including listening to professional explanation (4.64±0.58), watching operation video(4.61±0.53) and reading education brochures(4.59±0.60).ConclusionPatients have high health education need for EBUS-TBNA examinations and clinical staff should provide normalized health education pathway based on the patients' needs and improve the satisfaction of examination.
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During endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), a needle is commonly used with a stylet, although recently the stylet has been omitted. This prospective study aimed to compare the quality of specimens obtained by EBUS-TBNA performed with and without a stylet. Between November 2013 and November 2014, 131 patients with lung cancer underwent EBUS-TBNA, with a total of 148 mediastinal or hilar lymph nodes sampled both with and without an inner-stylet, yielding 296 cytological specimens. Specimens were scored cytologically using five parameters: background blood or clot, amount of cellular material, degree of cellular degeneration, degree of cellular trauma, and retention of appropriate architecture. The procedure with a stylet required significantly longer operation time than without a stylet (14.5±0.8 vs 12.7±1.1 min, P<0.001). Excellent specimens were obtained in 261/296 and 260/296 samples in the procedures with and without a stylet, respectively (P=0.9), while the remaining 35 and 36 samples, respectively, were adequate. The diagnosing and staging of lung cancer using EBUS-TBNA did not differ significantly between the groups. In conclusion, specimen collection by EBUS-TBNA without a stylet is easier and faster than the procedure using a stylet and absence of a stylet did not alter specimen quality or diagnostic accuracy.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Lung Neoplasms/pathology , Lymph Nodes/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Neoplasm Staging , Prospective StudiesABSTRACT
Transbronchial needle aspiration (TBNA), which has excellent sensitivity and specificity, is one of the key techniques of diagnostic interventional pulmonology. The conventional TBNA (C-TBNA) is routinely operated with ordinary bronchoscopy under local anesthesia. The efficacy of C-TBNA can be improved when rapid on-site evaluation (ROSE) is used during operating procedure. This paper describes technical essentials of ROSE-based C-TBNA.
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Objective To compare positron emission tomography/computed tomography(PET/CT)vs.endobronchial ultra-sound-guided transbronchial needle aspiration(EBUS-TBNA)in evaluating lymph node metastasis in NSCLC.Methods We col-lected 79 NSCLC patients with enlarged mediastinal lymph nodes(diameter >1 cm by CT).The diagnostic values of PET/CT scanning and EBUS-TBNA for mediastinal staging were evaluated.Subgroup analysis according to histologic type was per-formed.Results There were 22 patients of N1 stage and 28 patients of N2 in these 79 cases.In the N1 patients,PET/CT's sen-sitivity and specificity was 59.1% and 75.4%,respectively.EBUS-TBNA's sensitivity and specificity was 86.4% and 100.0%,respectively.In the N2 patients,PET/CT's sensitivity and specificity was 67.9% and 76.5% and EBUS-TBNA's sensitivity and specificity was 89.3% and 100.0%.Conclusion EBUS-TBNA is more accurate than PET/CT in evaluating the metastatic condition of patients,and EBUS-TBNA can also benefit PET/CT(-)patients with adenocarcinoma.
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Objective To evaluate the yield of conventional transbronchial needle aspiration (C-TBNA) in the diagnosis of patients with central airway peripheral lesions. Methods This was a retrospective study, 77 patients with central airway peripheral lesions were enrolled from January 2011 to March 2017. Specimens were smeared and/or embedded. Results The positive diagnostic value for malignant lesions were 92.86% (52/56), and 42.86%(9/21) for benign lesions. The average value was 79.22% (61/77). Conclusions C-TBNA had high positive rate of diagnosis and less complications for cent ral airway peripheral lesions.
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Objective To seek better anesthesia management methods for clinical applications guidance by retrospectively analyze the clinical effects of I-gel laryngeal mask for endobronchial ultrasound-guided transbronchial needleaspiration (EBUS-TBNA) performed under local and intravenous anesthesia modes. Methods Review the differences in the operative time, the number of SpO2 <95%, body motion, cough, laryngospasm, nausea, surgical puncture, operator suspension, postoperative throat discomfort, and satisfaction scores among the patient, the operator and the anesthetist between the two kinds of anesthesia of 60 patients for EBUS-TBNA in 3 years from 2013 to 2016. Results From June 2014, patients with I-gel laryngeal mask for EBUS-TBNA under intravenous anesthesia had fewer cough, nausea, physical activity, shorter operative time, and higher anesthesia satisfaction scores. Conclusion The perioperative management method of I-gel laryngeal mask for EBUS-TBNA in intravenous anesthesia is more secure and more feasible, recommended for clinical use.