Current status and clinical applicability of endobronchial ultrasound-guided transbronchial needle aspiration

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has played a key role in the diagnosis of mediastinal, paratracheal, and peribronchial lesions, as well as in lymph node staging for lung cancer. Despite its minimally invasive character, EBUS-TBNA has demonstrated a diagnostic yield comparable with that of established surgical methods. It has therefore gained credibility and has become a routine procedure at various referral centers. A successful EBUS-TBNA procedure requires careful planning, which includes a thorough review of the radiological imaging and special care during specimen collection and preparation, as well as technical expertise, experience with the procedure itself, and knowledge of the potential complications inherent to the procedure. The most common indications for EBUS-TBNA include lymph node staging for lung cancer and the diagnostic investigation of mediastinal/hilar masses and lymph node enlargement. Recently, tumor biomarkers in malignant samples collected during the EBUS-TBNA procedure have begun to be identified, and this molecular analysis has proven to be absolutely feasible. The EBUS-TBNA procedure has yet to be included on the Brazilian Medical Association list of medical procedures approved for reimbursement. The EBUS-TBNA procedure has shown to be a safe and accurate tool for lung cancer staging/restaging, as well as for the diagnosis of mediastinal, paratracheal, and peribronchial lesions/lymph node enlargement

Efficacy and adequacy of conventional transbronchial needle aspiration of IASLC stations 4R, 4L and 7 using endobronchial landmarks provided by the Wang nodal mapping system in the staging of lung cancer

“…Whether utilizing C‐TBNA or EBUS‐TBNA, adequacy and efficacy are extremely important for the staging of lung cancer. Many recent reports have reported successful results using EBUS‐TBNA for the staging of lung cancer . EBUS equipment is not as readily available as conventional bronchoscopes in many medical centers because of its high cost.…”

“…However, the variable sensitivity (37.0–94.7%) among operators has limited the adoption of this procedure for lung cancer staging . In contrast, endobronchial ultrasound (EBUS)‐TBNA has been demonstrated to be more reliable and has been recommended to aid the staging of lung cancer in recent years . Nonetheless, C‐TBNA remains a popular procedure in countries with limited access to EBUS technologies.…”

Pneumonectomy for Non–Small Cell Lung Cancer

“…PET scans are relatively sensitive for detecting mediastinal metastases; nevertheless, they are still not as accurate as mediastinoscopy and newer minimally invasive techniques for tissue acquisition like endobronchial ultrasound with transbronchial needle aspiration. [31][32][33][34] Thus, we believe that tissue biopsy (either with endobronchial ultrasound, preoperative mediastinoscopy, or thoracoscopy), is indicated for patients who may undergo pneumonectomy, even if they have a PET-negative mediastinum.…”

Diagnostic Efficacy and Safety of Endobronchial Ultrasound‐Guided Transbronchial Needle Aspiration in Intrathoracic Tuberculosis

“…Various techniques are available for obtaining pathologic material from intrathoracic masses, including computed tomographically guided percutaneous needle aspiration, conventional transbronchial needle aspiration (TBNA), endobronchial ultrasound‐guided TBNA (EBUS‐TBNA), transesophageal US‐guided needle aspiration, mediastinoscopy, and surgery. Endobronchial US‐guided TBNA is an important minimally invasive technique for diagnosis of mediastinal, paratracheal, and peribronchial lesions 7 , 8 . Compared with conventional TBNA, EBUS‐TBNA offers direct visualization of the target lesion and real‐time sampling, yields more nodal stations, and improves the diagnostic sensitivity 8 .…”