scholarly journals Transitioning to Combined EBUS EUS-B FNA for Experienced EBUS Bronchoscopist

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1021
Author(s):  
Jeffrey Ng ◽  
Hiang Ping Chan ◽  
Adrian Kee ◽  
Kay Leong Khoo ◽  
Kay Choong See
Keyword(s):  
Lymph Nodes ◽  
Learning Curves ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Learning Material ◽  
Mediastinal Lymph Nodes ◽  
Direct Supervision ◽  
Assessment Scores ◽  
Lung Cancer Diagnosis ◽  
Main Barrier

Endobronchial ultrasound (EBUS) combined with trans-esophageal endoscopic ultrasound bronchoscope guided fine need aspirate (EUS-B FNA) of mediastinal lymph nodes is an established procedure for diagnosis. The main barrier to a combined EBUS EUS-B FNA approach is availability of trained and accredited pulmonologist who can perform procedure safely and confidently. To address this gap, we undertook a training program for experienced EBUS bronchoscopists to train, learn, and incorporate combined EBUS EUS-B FNA into their procedural practice. Thirty-two patients were selected based on CT and or PET findings. Four experienced bronchoscopists participated by reading through learning material, observing 5 cases before performing EUS-B FNA under direct supervision. Forty-one lymph nodes and 6 non-nodal lesions were sampled. EUSAT assessment was performed by supervisor. Learning curves were derived from assessment scores. We observed that learning curve tends to plateau when participant can perform 3 or more consecutive cases with EUSAT score above 50. There were no complications. Our experience suggests that there is relative ease in transition to combined EBUS EUS-B TBNA procedures for mediastinal lymphadenopathy and lung cancer diagnosis and staging for experienced bronchoscopist using a program which incorporates direct supervision, EUSAT assessment, and extension of EUS B FNA training into daily real-world practice.

scholarly journals Endobronchial Ultrasound in Evaluating Mediastinal Lymphadenopathy

2021 ◽  
Author(s):  
Nandakishore Baikunje ◽  
Giridhar Belur Hosmane ◽  
Sunil Kumar Y.
Keyword(s):  
Lymph Nodes ◽  
Needle Aspiration ◽  
The Body ◽  
Nucleic Acid Amplification ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Body Parts ◽  
Mediastinal Lymph Nodes ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration

AbstractTuberculosis can involve most of the body parts, and tubercular lymphadenitis is common. But isolated involvement of mediastinal lymph nodes without lung parenchymal involvement is rare in adults. A 45-year-old lady presented with subcarinal lymph node enlargement. A conventional transbronchial needle aspiration done at a local hospital was inconclusive. Endobronchial ultrasound-guided transbronchial needle aspiration was done. Cytology showed epithelioid histiocytes and caseous necrosis. Stain for acid-fast bacilli and cartridge-based nucleic acid amplification test for tuberculosis were positive. Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive bronchoscopic technique to visualize and sample mediastinal lymph nodes. However, its availability is limited to specific centers and expertise is required to interpret images and take diagnostic samples.

scholarly journals Endobronchial ultrasound-guided transbronchial needle aspiration biopsy is useful evaluating mediastinal lymphadenopathy in a cancer center

CytoJournal ◽  
2011 ◽  
Vol 8 ◽  
pp. 10 ◽  
Author(s):  
Laila Khazai ◽  
Uma R. Kundu ◽  
Betsy Jacob ◽  
Shobha Patel ◽  
Nour Sneige ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Cancer Center ◽  
Mediastinal Lymph Nodes ◽  
Ultrasound Guided ◽  
One Year ◽  
Sensitivity Specificity

Background: Endobronchial ultrasound-guided tra0nsbronchial needle aspiration (EBUS-TBNA) biopsy is used to stage mediastinal lymph nodes in cancer patients to optimize treatment strategies. In this retrospective study, the authors determined the utility of EBUS-TBNA biopsy in the evaluation of mediastinal lymphadenopathy at a high-volume cancer center. Materials and Methods: The pathology database was searched for all patients who had undergone EBUS-TBNA biopsy of mediastinal lymph nodes over a one-year period. Cytologic diagnoses were correlated with clinical histories, subsequent resection, and clinical follow-up data. Results: Of 928 lymph node samples, 226 (24%) were diagnosed as malignant, 4 (0.4%) were suspicious for malignancy, 9 (1%) were atypical, 640 (69%) were benign, and 47 (5%) were insufficient for evaluation. In 89 (9.6%) cases, the patients had surgical resection. There was one false positive, in which the primary tumor contained infiltrating lymphocytes, had been sampled. There were five false-negative cases, which resulted from sampling errors, including two with micrometastases. The sensitivity, specificity, and positive and negative predictive value rates for EBUS-TBNA biopsy in the evaluation of mediastinal lymph nodes were 68.7% and 98.6% and 91.6% and 93.5%, respectively on a per lymph node basis. The overall clinical sensitivity, specificity, and positive and negative predictive value rates after one year clinical/radiological and histologic follow-up were 97%, 99.3%, 96.7% and 99.4%, respectively. Conclusions: EBUS-TBNA biopsy is a sensitive and specific method for evaluating mediastinal lymphadenopathy in patients with lung and other primary tumors.

scholarly journals The Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) Technique in Assessment of Mediastinal Lymph Nodes

2021 ◽  
Author(s):  
Shahab Rafieian ◽  
Reza Ershadi ◽  
Hossein Ebrahimpoor ◽  
Matin Vahedi
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Diagnostic Yield ◽  
Mediastinal Lymph Node ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Mediastinal Lymph Nodes ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration

Abstract Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) technique provides a complementary assessment of the areas of mediastinal lymph node involvement, and allows sampling of suspected lymph nodes. But, the usefulness of EBUS-TBNA in assessing all areas of mediastinal lymph nodes is little known and it seems that such assess is dependent to various factors related to the patient's condition and especially the characteristics of local lymph nodes. We aimed to evaluate the utility of EBUS-TBNA in assessing mediastinal lymph nodes and the factors associated with this utility.Methods: This cross-sectional study was performed on 40 patients suspected to mediastinal lymphadenopathy scheduled for assessment by EBUS-TBNA and mediastinoscopy. The diagnostic yield of EBUS-TBNA to mediastinal lymph nodes was evaluated and non diagnostic cases evaluated by mediastinoscopy .Results: In evaluation with EBUS-TBNA, the diagnostic yield of EBUS in assess to mediastinal lymph nodes including 34 out of 40 cases was equal to 85%. The size of lymph node (lower than 10mm), the area of sample (left and right upper paratracheal), and the nature of the lymph node sample (benign type) were associated with lower diagnostic yield for EBUS-TBNA.Conclusion: The diagnostic yield of EBUS in assessing mediastinal lymph nodes for sampling and diagnosis is 85%. This benefit is expected in the case of lesions larger than 10 mm, lesions of a malignant nature, as well as lesions in the inferior paratracheal and subcarinal stations.

scholarly journals EBUS in optimizing non-small cell lung cancer diagnosis and treatment

2020 ◽  
Author(s):  
Antonia Haranguș ◽  
Ioana Berindan-Neagoe ◽  
Lăcrămioara Toma ◽  
Ioan Șimon ◽  
Ovidiu Pop ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Molecular Analysis ◽  
Cancer Diagnosis ◽  
Predictive Value ◽  
Small Cell ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Small Cell Lung ◽  
Anaplastic Lymphoma ◽  
Lung Cancer Diagnosis

Background. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly used minimally invasive method for the diagnosis and staging of lung cancer. In order to improve its diagnostic accuracy, rapid on-site cytologic evaluation (ROSE) is being utilized in some institutions. ROSE, performed by a cytopathologist in the examination room, allows the assessment of the adequacy of the collected samples, identifies malignant cells and sometimes establishes diagnosis on the spot, thus improving diagnostic sensitivity. As non-small cell lung carcinomas (NSCLC) require not only pathological subtyping, but also molecular characterization, obtaining the adequate amount of tissue is crucial. Only a limited number of studies have analyzed the suitability of EBUS-TBNA samples for assessment of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and programmed death-ligand 1 (PD-L1) status. Aim. We intended to examine the diagnostic yield of ROSE in NSCLC and the results and feasibility of molecular analysis performed on EBUS-TBNA small samples. Methods. 100 patients with lung tumors and hilar and/or mediastinal lymphadenopathy on CT or PET/CT scans were retrospectively identified over a 3-year period, from a prospectively maintained EBUS-TBNA database. All examinations were accompanied by on-site cytological exam - ROSE, histopathological exam (HPE) and, in the case of NSCLC, molecular testing. After the sampling of the lymph nodes, specimens were Diff-Quik stained and a rapid preliminary diagnosis was established. Immunohistochemistry and mutational testing were performed using cell blocks. Results. Adenocarcinoma was the most frequent diagnosis in both ROSE (34%) and histopathology (53%). Overall sensitivity and positive predictive value of ROSE in NSCLC, considering HPE the gold standard, were 92.18% and 93.65%, respectively, with a specificity and negative predictive value of 75% and 70.58%, respectively. All samples that were tested for EGFR mutation and ALK rearrangement were adequate for analysis. The adequacy ratio for PD-L1 was 91.66%; 37.5% of patients showed a high PD-L1 expression level, with a tumor proportion score TPS≥50%. Conclusion. EBUS-TBNA is a valuable method for lung cancer diagnosis. ROSE proved to have a moderate prediction of the final diagnosis in NSCLC. Molecular analysis of EGFR, ALK and PD-L1 can be successfully accomplished on EBUS-TBNA small tissue samples.

Forceps Biopsy Of The Mediastinal Lymph Nodes Using Endobronchial Ultrasound (EBUS): A Proposed Technique

2012 ◽  
Author(s):  
Dhruvang Modi ◽  
Dipaben Patel ◽  
Trushil Shah ◽  
Kathleen L. Copelen ◽  
Dana Dexheimer ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymph Nodes ◽  
Forceps Biopsy
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