Efficacy and safety of EBUS‐TBNA and EUS‐B‐FNA in children: A systematic review and meta‐analysis

Madan, Karan; Iyer, Hariharan; Madan, Neha Kawatra; Mittal, Saurabh; Tiwari, Pawan; Hadda, Vijay; Mohan, Anant; Pandey, Ravindra M.; Kabra, Sushil Kumar; Guleria, Randeep

doi:10.1002/ppul.25124

Cited by 21 publications

(15 citation statements)

References 27 publications

(84 reference statements)

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“…EBUS-guided TBNA is an established diagnostic tool in adults, but still infrequently applied in pediatric respiratory medicine due to the requirement of a large-diameter bronchoscope. Our single-center experience in 45 consecutive subjects, the largest case series reported to date, expands current evidence on the procedure's efficacy and safety as recently reviewed by Madan et al 2 Our use of EBUS and lymph node biopsy almost tripled the bacteriological confirmation rate in comparison to sputum-or gastric aspirate-based testing alone. Bronchoscopic BAL only increased the confirmation rate by a factor of 1.3 relative to standard testing, and additional TBNA resulted in a further doubling of the diagnostic yield.…”

Section: To the Editorsupporting

confidence: 74%

Safety and diagnostic yield of endobronchial ultrasound-guided lymph node biopsy in children and adolescents with suspected tuberculosis

Barker¹,

Günther²,

Wurps³

et al. 2021

Preprint

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Referring to a literature review published recently in this Journal, we report a single-center case series of 45 children and adolescents (age 2-17 years) with suspected tuberculosis (TB) and negative microscopy on repeated sputum or gastric aspirate samples. All subjects underwent flexible airway endoscopy including bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) without adverse events. Among 41 subjects with a final TB diagnosis, Mycobacterium tuberculosis was detected by PCR and/or culture in 20 (49% bacteriological confirmation) with 11 cases relying exclusively on results from TBNA samples. Only 7 of 17 positive culture results related to sputum (17% confirmation rate), and 9 of 17 on the combination of sputum and BAL (22%) respectively. The sampling site of a person’s first positive culture was TBNA in 13 of 17 cases (76%). Bacteriological confirmation was essential for diagnostic accuracy and tailored treatment based on individual drug susceptibility testing. We therefore recommend the inclusion of bronchoscopy and EBUS-TBNA in a comprehensive diagnostic protocol for smear-negative pediatric TB suspects.

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Section: To the Editorsupporting

confidence: 74%

Safety and diagnostic yield of endobronchial ultrasound-guided lymph node biopsy in children and adolescents with suspected tuberculosis

Barker¹,

Günther²,

Wurps³

et al. 2021

Preprint

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“…The diagnostic yield is acceptable and may avoid the need for invasive biopsy procedures in majority. [ 2 4 9 10 11 12 13 14 ] EUS-B-FNA may be performed in children even 3 years and younger for sampling the esophageal accessible lymph nodes. [ 15 ] However, one needs to highlight that performing EBUS-TBNA and EUS-B-FNA in children requires reasonable expertise and experience with EBUS-TBNA.…”

Section: Discussionmentioning

confidence: 99%

“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard of care modality for evaluating mediastinal lymphadenopathy and mediastinal lesions in adults and children. [ 1 2 3 4 ] Ever since EBUS-TBNA was introduced into the realm of clinical pulmonology in 2003, it has revolutionized the approach towards evaluating mediastinal lymphadenopathy and other mediastinal lesions. [ 5 ] However, like flexible bronchoscopy, there is variability in the performance technique in different settings.…”

Section: Introductionmentioning

confidence: 99%

A Survey of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) practices in India

et al. 2022

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Background: There is a lack of data on the prevalent practices of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in India. Aim: To study the current practices of EBUS-TBNA in India. Methods: This survey was an online questionnaire designed on the Google forms interface. The survey included various questions related to demographics, sedation, analgesia and anesthesia, technical aspects, and infection control related to the procedure of EBUS-TBNA. Results: Data from 134 respondents (mean age: 42.2 years) were analyzed. Most (97.8%) were pulmonologists or physicians, and a majority (94.8%) practicing in either a private multi-specialty setting or medical college. 40.3% had received procedure training at a formal training program. Mild/moderate sedation was the most common strategy (70.1%). Midazolam (76.7%), Fentanyl (76.0%), followed by propofol (46.5%), were the most frequent drugs, and 82.8% preferred combination sedation. 26.1% used cricothyroid lignocaine injection, and the use of 1% or 2% lignocaine for spray-as-you-go administration was similar. The oral route was preferred, while the laryngeal mask airway was the most common airway conduit under general anesthesia. Suspected granulomatous mediastinal lymphadenopathy (TB/sarcoidosis) (67.2%), followed by lung cancer (32.8%), were the most common indications of EBUS-TBNA. 81.3% performed EBUS-TBNA for lung cancer staging. 21 G needle was preferred (64.9%), and vacuum suction was common (80.6%). 55.2% routinely performed ROSE. Alcohol fixed glass slide smears were the most common method (93.1%) for cytological preparation. 49.3% also performed EUS-B-FNA. 76.9% routinely obtained endo bronchial biopsy and transbronchial lung biopsy in patients with suspected sarcoidosis. Elastography was infrequently used. Nearly three-fourths (77.6%) reused EBUS needles. Conclusion: There is practice variability in the multiple aspects related technical performance of EBUS-TBNA. Evidence-based guidelines addressing the multiple technical aspects are required to standardize the practice of EBUS-TBNA.

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“…Madan concluded that EBUS-TBNA and EBUS-B-FNA is safe in children with mediastinal lymphadenopathy; it may be considered as the first-line diagnostic modality. 50 Radial probe EBUS employs a flexible catheter housing a rotating ultrasound transducer, which produces a 360-degree ('radial') ultrasound image and was first used to guide TBLB by Herth et al 51 These radial probes are compatible with channel diameters from 2.0 mm to 2.8 mm. They can be inserted directly through the working channel or used with a guide sheath.…”

Section: Transbronchial Needle Aspirationmentioning

confidence: 99%

The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis

Goussard

Retief

Burke

et al. 2021

Therapeutic Advances in Infection

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Bronchoscopy is useful as a diagnostic and therapeutic procedure in children with Tuberculosis (TB) disease complicated by airway obstruction. It is needed in children when surgical intervention may be required for airway compression, when drug resistance is suspected, and to rule out an alternative diagnosis for airway obstruction. Bronchoscopy with bronchoalveolar lavage (BAL) should be performed when other, less invasive samples cannot be collected, or when they fail to provide useful diagnostic information. BAL specimens collected at bronchoscopy can be tested using molecular TB assays and mycobacterial culture. The aim of this review is to evaluate the role of bronchoscopy in the diagnosis and management of pulmonary TB in children, and, specifically, to review the role of interventional bronchoscopy. A search of electronic databases was undertaken using the online databases PubMed, Ovid MEDLINE, EMBASE, Google Advanced Scholar, and Web of Science to identify relevant literature. The search was limited to pediatrics, pulmonology, bronchoscopy, and pediatric pulmonary tuberculosis for all articles published in English on pediatric bronchoscopy between 2010 and 2020. Recent advances in pediatric bronchoscopy was included, as well as recent research on improving the diagnosis with the use of interventional bronchoscopy. The role of bronchoscopy in pediatric pulmonary tuberculosis has changed during the last decade, from a simple method of collecting samples for bacteriological conformation to an more sophisticate procedure. New methods are available for collecting samples, which includes the use of Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and also better methods of bacteriological conformation. Interventions are now possible; not only to improve the diagnostic abilities of bronchoscopy but also to diagnose, manage, and follow-up upon airway-related complications. Bronchoscopy services remain limited in resource-limited countries due to the high cost of equipment.

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Efficacy and safety of EBUS‐TBNA and EUS‐B‐FNA in children: A systematic review and meta‐analysis

Cited by 21 publications

References 27 publications

Safety and diagnostic yield of endobronchial ultrasound-guided lymph node biopsy in children and adolescents with suspected tuberculosis

Safety and diagnostic yield of endobronchial ultrasound-guided lymph node biopsy in children and adolescents with suspected tuberculosis

A Survey of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) practices in India

The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis

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