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Background & objectives: Recently, there has been a surge to develop new devices and techniques for the diagnosis of peripheral pulmonary lesions such as the combination of LungPoint navigation and endobronchial ultrasound with a guide sheath (EBUS-GS). The present study aimed to explore the diagnostic value of LungPoint navigation in combination with EBUS-GS and rapid on-site evaluation (ROSE) particularly for peripheral pulmonary nodules. Methods: Patients (n=108) with pulmonary nodules (10 mm ? nodal diameter ?30 mm) presenting to Henan Provincial People’s Hospital were detected using chest computed tomographic (CT) scanning and bronchoscopy. All patients were evaluated using LungPoint navigation, EBUS-GS and ROSE techniques to evaluate the positive rate of combined diagnosis using the three methods. Results: A total of 108 patients participated in this study and successfully underwent all the three procedures. Of these, 82 patients were accurately diagnosed, making the overall diagnostic rate of 75.9 per cent for combined LungPoint navigation, EBUS-GS, and ROSE analyses. Further subgroup analysis of the diagnostic rate of the three combined techniques were conducted based on the size of the nodules which showed a diagnostic rate of 65.3 per cent for 10 mm ? nodule diameter ?20 mm and 85.7 per cent for 20 mm ? nodal diameter ?30 mm. Of the 108 patients, 85 had solid nodules and 23 had ground-glass nodules; the positive rate of diagnosis of solid nodules was the highest. The patients ultimately were diagnosed with lung cancer with a positive rate of 83.5 per cent. The sensitivity, specificity and positive and negative predicted values for ROSE were 90.3, 78.3, 84.8 and 83.6 per cent, respectively. Interpretation & conclusions: The combined use of the three techniques can effectively shorten the duration of the total diagnosis period and improve the safety of diagnosis without affecting the detection rate.
Subject(s)
Humans , Female , Aged , Bronchoscopy , Endoscopic Ultrasound-Guided Fine Needle Aspiration , UltrasonographyABSTRACT
Abstract Evidence of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in extrathoracic malignancy is limited but emergent. The technique plays a vital role in the diagnosis of mediastinal lesions, staging, and restaging of lung cancer. Its usefulness for the evaluation and molecular classification of progressive breast cancer is described in 7 patients. Stations 7, 11L, and 11R were punctured. Cellblocks, immunohistochemistry and digital analysis were developed in 100% of the cases for molecular classification. This procedure requires multidisciplinary evaluation, image analysis, and evaluation of the general condition of the patient, as well as the risks and benefits. Additionally, it is essential teamwork with a pathology group that performs the rapid on-site evaluation (ROSE), in order to ensure the quality of the samples and molecular characterization.
Resumen Evidencia de la aspiración transbronquial con aguja guiada por ultrasonido endobronquial en malignidad extratorácica es limitada pero emergente. Esta técnica desempeña un papel vital en el diagnóstico de lesiones mediastinales, estadificación y reestadificación del cáncer pulmonar. Se describe su utilidad para la evaluación y la clasificación molecular del cáncer de mama en progresión de siete pacientes. Se puncionaron las estaciones (ganglionares) 7, 11L y 11R. Se desarrollaron bloques celulares, inmunohistoquímica y análisis digital en el 100% de los casos para clasificación molecular. Este procedimiento requiere una evaluación multidisciplinaria, análisis de imágenes y la evaluación del estado general de la paciente, lo mismo que los riesgos y los beneficios. Adicionalmente, es esencial el trabajo conjunto con un grupo de patología que realice la evaluación rápida en sala (ROSE), para así asegurar la calidad de las muestras y la caracterización molecular.
Subject(s)
Humans , Breast Neoplasms , Biopsy, Needle , Lung NeoplasmsABSTRACT
Background: Conventional TBNA has been used in the evaluation of intrathoracic lymphadenopathy with varied success rates depending upon size, site and aetiology of the node. Although mediastinoscopy has higher successes but it comes at the cost of general anaesthesia, more complications and limited access to the inferior and posterior mediastinum. Endobronchial ultrasound guided transbronchial needle aspiration has the advantage of real time nodal sampling with good success rates and minimal complications. The aim of our study was to assess the diagnostic yield and safety of EBUS TBNA in the evaluation of intrathoracic lymphadenopathy.Methods: This prospective observational study was conducted at government chest diseases hospital Srinagar over a period of two years from January 2016-December 2018 on 100 consecutive patients who underwent EBUS TBNA procedure for evaluation mediastinal and hilar lymphadenopathy. The data was collected and analysed for diagnostic yield and safety profile.Results: Out of the 100 subjects included in the study 52% were males and 48% were females. Mean age of the study population was 48.5±16.65 years. Most of the nodes sampled were subcarinal in location followed by paratracheal and hilar group. Granulomatous pathology (tuberculosis and sarcoidosis) was present in 41 patients followed by malignancy in 39 patients. Anthracosis was the cause of lymphadenopathy in 4 of the patients. There were no major complications in our study.Conclusions: EBUS TBNA is an effective and safe procedure for evaluation of mediastinal and hilar lymphadenopathy.
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PURPOSE: Identification of lymph node (LN) metastasis in non-small cell lung cancer (NSCLC) is critical for disease staging and selection of therapeutic modalities. Sometimes it is not possible to obtain LN core tissue by endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA), resulting in low diagnostic yield. MATERIALS AND METHODS: In this study, 138 specimens were collected from 108 patients who underwent EBUS-TBNA under the suspicion of LN metastasis of NSCLC. Diagnostic yields of anti-CD45 and anti-methionyl-tRNA synthetase (MRS), immunofluorescent (IF) staining on cytology specimens were compared with those of conventional cytology and positron emission tomography-computed tomography (PET-CT). RESULTS: MRS was strongly expressed in NSCLC cells metastasized to LNs, but weakly expressed in cells at the periphery of the LN germinal center. The majority of cells were CD20 positive, although a few cells were either CD3 or CD14 positive, indicating that CD45 staining is required for discrimination of non-malignant LN constituent cells from NSCLC cells. When the diagnostic efficacy of MRS/CD45 IF staining was evaluated using 138 LN cellular aspirates from 108 patients through EBUS-TBNA, the sensitivity was 76.7% and specificity was 90.8%, whereas those of conventional cytology test were 71.8% and 100.0%, respectively. Combining the results of conventional cytology testing and those of PET-CT showed a sensitivity and specificity of 71.6% and 100%, and the addition of MRS/CD45 dual IF data to this combination increased sensitivity and specificity to 85.1% and 97.8%, respectively. CONCLUSION: MRS/CD45 dual IF staining showed good diagnostic performance and may be a good tool complementing conventional cytology test for determining LN metastasis of NSCLC.
Subject(s)
Humans , Amino Acyl-tRNA Synthetases , Carcinoma, Non-Small-Cell Lung , Complement System Proteins , Discrimination, Psychological , Electrons , Germinal Center , Ligases , Lymph Nodes , Methionine-tRNA Ligase , Needles , Neoplasm Metastasis , Sensitivity and SpecificityABSTRACT
Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the early diagnosis of non-central small cell lung cancer.Methods 141 patients wereselected from July 1999 to June 2017,who were diagnosed with small cell lung cancer (stage N2 and N3).They were divided into two groups according to the approach of obtaining histopathological tissuefor diagnosis.49 cases in the experimental group were obtained by EBUS-TBNA,92 cases in the control group were done by video assisted thoracic surgery (40 cases,43.5％),mediastinoscopy (1 case,1.1％),and open procedure (51 case,55.4％).Survival outcome,time of waiting for the treatment and lengthof stay were analyzed.Results There werel09 males,32 females,the range of age is from 16 to 79 years old [(56.21 ± 11.48) years].62 lesions located in the upper lobe,12 in the middle lobe,56 in the lower lobe,11 in the middle-lower/-upper lobes.Considering the T stage,there are 7 cases of T1,61 cases of T2,45 cases of T3,and 26cases of T4,2 patients with Tx stage.Compared with conventional approach,EBUS-TBNA saved 10.78 days from admission to the time of receiving treatment [(4.62 ± 0.66)days vs.(15.40 ± 1.61) days,P ＜ 0.05],and saved 18.13 days of length of stay [(5.30 ± 0.76) days vs.(23.43 ± 2.44) days,P ＜0.05].5-year survival rate was 31.0％ for traditional group and 27.5％ for EBUS-TBNA group,there was no significant difference between two groups(P =0.308).Conclusion EBUS-TBNA couldsave the waiting days from admission to the time of receiving treatment,and also shorten the total length of stay.EBUS-TBNA was more efficient than conventional approaches (VATS,mediastinoscopy or open procedure) for diagnosing non-central small cell lung cancer with enlarged mediastinal lymph nodes.
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Objective: Four ultrasound elastography parameters were used to compare the color distribution of mediastinal and hilar lymph nodes (LNs) in endobronchial ultrasound real-time elastography (EBUS-RTE), and the clinical value in differentiating benign from malignant mediastinal and hilar lymph nodes were explored. Methods: We selected patients who received EBUS-TBNA in the Second Hospital of Lanzhou University from January 2016 to December 2018 and simultaneously conducted EBUS-RTE. Elastography of lymph nodes were analyzed by elastography image type, elasticity score, strain ratio (SR), and blue color proportion (BCP), respectively. A re-ceiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of the four ultrasound elastography pa-rameters. The area under the curve (AUC) and the critical value of the best diagnosis were calculated, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the four parameters were compared. Results: A total of 80 pa-tients were enrolled, including 152 lymph nodes with 102 malignant lymph nodes and 50 benign ones. Elastography image type, elas-ticity score, SR, and BCP had statistical significance in the differential diagnosis of benign and malignant lymph nodes (P<0.01). The ac-curacy of BCP in the diagnosis of benign and malignant lymph nodes was the highest (88.3%), and the sensitivity, specificity, positive predictive value, and negative predictive value were 90.0%, 94.1%, 85.4%, and 88.6%, respectively. The optimal definition value of BCP was 85.7%; all the 65 LNs with a BCP≥85.7% were diagnosed as malignant. Conclusions: Elastography image type, elasticity score, SR, and BCP of ultrasound elastography are important in the differential diagnosis of mediastinal and hilar lymph nodes, and BCP showed the highest diagnostic valuation.
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Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and conventional-transbronchial needle aspiration (C-TBNA) in mediastinal and lung hilar lesions. Method 301 cases of lung hilar and mediastinal lesions were selected from 2010 to 2016. Among them, 183 cases underwent TBNA, and the other 118 cases received EBUS-TBNA technology. During the research, the associations of diagnostic positive rate and complications were analyzed in order to explore the advantage and the value of EBUS-TBNA. Results The positive rates of EBUS-TBNA in central groups (2R, 4L, 4R, 7) were higher than in the peripheral groups (10R, 10L, 11R, 11L) (P 0.05), an approving effect of puncture can be acquired; The accuracy and sensitivity of EBUS-TBNA in the diagnosis of lung hilar and mediastinal lesions were much better than conventional TBNA (P 0.05), there were no severe complications during the operations in all cases. Conclusion EBUS-TBNA is useful in diagnosis of mediastinal and hilar lesions of unknown reason, and significant in diagnosis of bronchial and extrabronchial diseases. It is an efficiency and safe operation while further application studies are needed.
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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.
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Objective To assess the diagnosis value of endorbronchial ultrasonography with a guide sheath combination with virtual bronchoscopic navigation at peripheral lung lesions. Methods 23 patients with lung peripheral lesions, 10 cases male, 13 cases female, age 29~78, the median age of 61, were retrospectively analyzed by diagnosised with EBUS-GS-TBLB combination VBN from March 2015 to December 2015. Results 23 cases of patients, 8 cases of adenocarcinoma, squamous carcinoma in 5 cases, mixed carcinoma in 1 case, 1 case of small cell carcinoma and lung metastatic carcinoma in 1 case, 2 cases were tuberculosis, 1 case of inflammation, 4 cases were negative. The total positive rate was 82.6%. Conclusion EBUS-GS-TBLB combination with VBN to the diagnosis of lung lesions with high positive rate, it is worthy of promoting clinically.
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Objective To investigate the value of EBUS-TBNA (endobronchial ultrasound-guided trans-bronchial needle aspiration) in diagnosis of lung cancer and analyze its complications. Methods A retrospective study was carried out in our hospitalfrom March 2013 to March 2015. A total of 171patients received C-TBNA (Con-ventional transbronchial needle aspiration) first and got negative results. Therefore, they received EBUS-TBNA next. Weanalyzedthe sensitivity, specificity, accuracy of malignancy with EBUS-TBNA and positive (malignant) lymph node sites biopsied with EBUS-TBNAand the incidence of its complications. Results Lung cancer was proven in 107 patients who had received EBUS-TBNA, while 16 were benign cases. Thirty-onenegative patients received CT guided needle biopsy or surgeryfor finally pathology. Based on above statistical data , we calculated EBUS-TBNA′s sensitivity, specificity and accuracy in 88.42%, 100.00%and 94.21%respectively. A totalof 818 lymph nodes were punctured by EBUS-TBNA, 408 were malignancy. The rate of diagnosis for malignancy was 49.88%. The complica-tioncontained 1 in hemorrhage, 1 in infectionand no life-threatening conditionandno death. Conclusion The value ofdiagnosis in lung cancerisrelatively high with EBUS-TBNAin safety and efficient.
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La Broncoscopia es sin duda el ámbito de medicina respiratoria que más ha sufrido cambios en los últimos 30 años. Principalmente dado por los avances tecnológicos que han permitido llegar, ver y hacer mucho más de lo que se pensó que era factible por vía endoscópica.
The most evolved area in the respiratory medicine in the last 30 years, is without any doubt the Bronchoscopy. This are the results of the tecnological advances, that let us go, see and do, further than we thougth by endoscopy.
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Humans , Respiratory Tract Diseases/surgery , Respiratory Tract Diseases/diagnosis , Bronchoscopy/methods , Bronchoscopy/trends , Video Recording , User-Computer Interface , Bronchoscopy/instrumentation , Ultrasonography , Microscopy, Confocal , Tomography, Optical Coherence , Electromagnetic Phenomena , FluorescenceABSTRACT
A 61-year-old woman who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) five years previously referred for a cervical retrotracheal mass. The mass had intense fluorodeoxyglucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT), and was thus thought to be malignant. Transcutaneous ultrasonography with fine needle aspiration (FNA) was not feasible, so we tried endobronchial ultrasonography (EBUS) with transbronchial needle aspiration (TBNA) to obtain a cytology specimen. After surgery, the mass was confirmed to be a metastatic lymph node from the previous PTC, confirming the TBNA results. Although the utility of EBUS-TBNA for evaluating mediastinal metastasis has been reported in a number of studies, few reports have addressed its utility in the cervical region. Here we report this unusual case of metastatic lymph node of PTC that recurred in the cervical retrotracheal area. It was found to exhibit esophageal muscular invasion, and was accurately diagnosed on EBUS-TBNA.
Subject(s)
Female , Humans , Middle Aged , Biopsy, Fine-Needle , Electrons , Lymph Nodes , Needles , Neoplasm Metastasis , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , UltrasonographyABSTRACT
Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in intrathoracic tuberculosis(TB).Methods We retrospectively analyzed patients underwent EBUS-TBNA with a final diagnosis of intrathoracic TB at Shanghai Chest Hospital from October 2009 to March 2013 and observed that the diagnostic efficacy by pathology and microbiology and safety of EBUS-TBNA for intrathoracic TB.Results 75 patients were diagnosed with pulmonary TB or intrathoracic tuberculous lymphadenitis,and accuracy was 80％ (60/75) by EBUS TBNA.A total of 60 patients had pathology,acid-fast bacilli(AFB) staining and mycobacterial culture test results,of whom 52 (86.67％)were diagnosed.Pathological findings were consistent with TB in 77.33％ patients (58/75),in 20.31％ (13/64) the smear were positive for AFB and in 46.67％ (28/60) were positive for cuhure.One hundred and twenty-nine mediastinal or hilar lymph nodes and 10 intrapulmonary lesions were biopsied in 75 patients,the average target number of per patient were 1.85.Pathological findings were consistent with TB in 66.19％ samples(92/139),in 13.91％ (16/115) were positive for AFB and in 38.32％ (41/107) were positive for culture.Multivariate regression revealed that short-axis diameter was an independent risk factor associated with positive pathology,smear and euhure.Additionally,more aspiration times cause higher pathology positive rate,pathology showing necrosis and positive smear were independent risk factors associated with positive cuhure.There were two patients occurred complications during operation.Conclusion EBUS-TBNA was a safe and effective method for the diagnosis of intrathoracic tuberculosis.
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The identification of mediastinal lymph nodes (LNs) in lung cancer is an important step of treatment decision and prognosis prediction. The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to assess the mediastinal LNs and tissue confirmation in lung cancer. As use of bronchoscopy or EBUS-TBNA has been increased, bronchial anthracofibrosis (BAF) has been detected frequently. Moreover, BAF is often accompanied by mediastinal lymphadenopathy and showed false-positive positron emission tomography uptake, which mimics metastatic lymphadenopathy in lung cancer patients. However, clinical implication of BAF during bronchoscopy is not well understood in lung cancer. We retrospectively reviewed 536 lung cancer patients who performed EBUS-TBNA and observed BAF in 55 patients. A total of 790 LNs were analyzed and macroscopic tissue pigmentation was observed in 228 patients. The adjusted odds ratio for predicting malignant LN was 0.46 for BAF, and 0.22 for macroscopic tissue pigmentation. The specificity of BAF and macroscopic tissue pigmentation for predicting a malignant LN was 75.7% and 42.2%, respectively, which was higher than the specificity of using LN size or standard uptake value on PET. In conclusion, BAF and macroscopic tissue pigmentation during EBUS-TBNA are less commonly found in malignant LNs than reactive LNs in Korean lung cancer patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Asian People , Biopsy, Fine-Needle , Bronchi/pathology , Bronchoscopy , Carcinoma, Non-Small-Cell Lung/pathology , Constriction, Pathologic , Logistic Models , Lung Neoplasms/pathology , Lymph Nodes/pathology , Lymphatic Diseases/pathology , Lymphatic Metastasis , Odds Ratio , Pigmentation , Positron-Emission Tomography , Predictive Value of Tests , Republic of Korea , Retrospective Studies , Small Cell Lung Carcinoma/pathology , Ultrasonography, InterventionalABSTRACT
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) now provides an important alternative diagnostic modality in patients with intrathoracic tuberculosis lymphadenopathy. The procedure is well tolerated in the outpatient setting, provides access to the mediastinal and hilar lymph node locations commonly in tuberculosis and also allows bronchial washing to be performed at the same procedure. However, there is no report of EBUS-TBNA applied to children to diagnose tuberculosis. We report a case of EBUS-TBNA applied to children who had intrathoracic tuberculosis lymphadenopathy.
Subject(s)
Child , Humans , Lymph Nodes , Lymphadenitis , Lymphatic Diseases , Needles , Outpatients , Tuberculosis , UltrasonographyABSTRACT
Objective To evaluate the clinic efficacy of sufentanil and remifentanil by target- controlled infusion (TCI) combined with propofol in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods Sixty patients,ASA Ⅰ ～ Ⅱ,undergoing elective EBUS-TBNA were randomly divided into group S ( sufentanil group),group R (remifentanil group) and group SR (sufentanil + remifentanil group),each group were twenty patients.The anesthesia of all groups is propofol intravenous anesthesia with 2％ lidocaine topical anesthesia,to controll BIS between 50 and 60 during surgery.Heart rate(HR),mean arterial pressure(MAP) pulse oxygen saturation( SpO2 ) and respiratory rate (RR) were recorded and compared 5mins after entering room(T0),30mins after the beginning of surgery(T1 ) and after surgery(T3).Arterial blood gas and the times of cough during surgery were also recorded and compared in all groups.The use of propofol and lidocaine,the wake-up time,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were also obtained.Results ( 1 ) RR decreased distinctly in group R and PaCO2 increased distinctly in group S and group R compared with that of group SR (P ＜0.05) during surgery.(2)The times of cough and the wake-up time lessened distinctly in group R and group SR compared with that of group S ( P ＜0.05 ).(3) The use of propofol and lidocaine,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were similar in all groups ( P ＞ 0.05 ).Conclusion Sufentanil compounded remifentanil by TCI combined with propofol is a safe and feasible anesthesia option for EBUS-TBNA,which provides better efficacy,high satisfaction and less side effects compared with using alone of sufentanil and remifentanil respectively.
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Mediastinal lymphadenopathy associated with extrathoracic malignancy or a metastasis of unknown origin (MUO) requires pathological verification. Surgical exploration or endoscopic ultrasound-guided fine needle aspiration is limited to application. We investigated the effectiveness of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) for evaluating mediastinal lymphadenopathy in patients with an extrathoracic malignancy. We retrospectively analyzed data from 59 patients who underwent EBUS-TBNA with a core biopsy because of a suspected mediastinal metastasis between September 2008 and August 2010. All patients had previously been diagnosed with an extrathoracic malignancy (n = 39, 66.1%) or a suspected MUO without a thoracic lesion (n = 20, 33.9%). A total of 88 lymph nodes was analyzed. EBUS-TBNA findings indicated malignancies in 34 patients (57.6%). The EBUS-TBNA sensitivity and specificity for the detection of mediastinal malignancy in patients with a previous extrathoracic malignancy were 96.3% and 100%, respectively. For MUO patients without a thoracic lesion, the sensitivity and specificity were 61.5% and 100%, respectively. The overall sensitivity and specificity were 81.0% and 100%, respectively (P = 0.053). EBUS-TBNA is a safe and effective modality for evaluating mediastinal lymphadenopathy in patients with a previous extrathoracic malignancy or a MUO without a thoracic lesion. The application of this diagnostic tool is likely to have significant clinical implications.