Endobronchial Ultrasound-Guided Fine-Needle Aspiration of Mediastinal Lymph Nodes: A Single Institution's Early Learning Curve

Groth, Shawn S.; Whitson, Bryan A.; D’Cunha, Jonathan; Maddaus, Michael A.; Alsharif, Mariam; Andrade, Rafael S.

doi:10.1016/j.athoracsur.2008.06.042

Cited by 96 publications

(101 citation statements)

References 38 publications

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“…One group of authors chose to exclude the results of the first 10 patients from their data, on the grounds that this would be the number of procedures required for completion of the learning curve. (17) A final point worth commenting upon is the role of TBNA. A study comparing TBNA with EBUS-TBNA in the staging of lung cancer concluded that, except for the subcarinal station 7, the diagnostic yield of EBUS-TBNA was higher than that of TBNA in the other mediastinal lymph node stations.…”

Section: Discussionmentioning

confidence: 99%

“…The advantage of using EBUS over mediastinoscopy is that the former allows access to a larger number of mediastinal lymph node stations than does the latter, as reported in one study (a diagnostic rate of 87.5% in stations 10 and 11). (17) However, we must consider that, although these stations are relevant for obtaining a more accurate staging, they have no impact on the decision-making process regarding surgical treatment. (17) Another argument that has been made in favor of EBUS is that it is less invasive than is mediastinoscopy, which, despite a complication rate of less than 1%, can cause severe complications.…”

Section: Discussionmentioning

confidence: 99%

“…(17) However, we must consider that, although these stations are relevant for obtaining a more accurate staging, they have no impact on the decision-making process regarding surgical treatment. (17) Another argument that has been made in favor of EBUS is that it is less invasive than is mediastinoscopy, which, despite a complication rate of less than 1%, can cause severe complications. (18,19) It has also been emphasized that, in cases of reassessment of the mediastinum after previous mediastinoscopy, surgical lymph node drainage, or neoadjuvant therapy, EBUS is safer than a second mediastinoscopy because of the fibrosis following mediastinoscopy.…”

Section: Discussionmentioning

confidence: 99%

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Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

et al. 2012

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Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of mediastinal lymph nodes. The objective of this study was to evaluate the preliminary results obtained with EBUS-TBNA in the diagnosis of lesions and mediastinal lymph node staging. Methods: We evaluated patients with tumors or mediastinal adenopathy, diagnosed with or suspected of having lung cancer. The procedures were performed with the patients under sedation or under general anesthesia. Material was collected by EBUS-TBNA, after which it was prepared on slides, fixed in either absolute alcohol (for cytology) or formalin (for cell-block analysis). Results: We included 50 patients (30 males). The mean age was 58.3 ± 13.5 years. We performed 201 biopsies of 81 lymph nodes or mediastinal masses (mean of 2.5 punctures/biopsy). The quantity of material was considered appropriate for cytology in 37 patients (74%), 21 (57%) of whom were thus diagnosed with malignancy. Of the remaining 16 patients, 1 was diagnosed with tuberculosis, 6 entered clinical follow-up, and 9 underwent further investigation (2 diagnosed with neoplasmfalse-negative results). The yield was higher when the procedure was performed for diagnostic purposes, as well as being higher in patients with lesions in multiple stations and in biopsies involving the subcarinal lymph node station. One patient had endobronchial bleeding, which was resolved with local measures. There were no deaths among the patients evaluated. Conclusions: This preliminary experience shows that EBUS-TBNA is a safe procedure. Our diagnostic yield, although lower than that reported in the literature, was consistent with the learning curve for the method.Keywords: Ultrasonography, interventional; Biopsy, fine-needle; Neoplasm staging; Lung neoplasms; Bronchoscopy. ResumoObjetivo: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa por agulha guiada por ultrassom endobrônquico) é um método novo em diagnóstico e estadiamento linfonodal mediastinal. O objetivo do estudo foi avaliar os resultados preliminares obtidos com EBUS-TBNA no diagnóstico de lesões e no estadiamento linfonodal mediastinal. Métodos: Foram avaliados pacientes com tumores ou adenopatias mediastinais e com diagnóstico ou suspeita de câncer de pulmão. Os procedimentos foram realizados com os pacientes sob sedação ou anestesia geral. O material coletado foi preparado em lâminas fixadas em álcool absoluto para citologia e em formol para bloco de células. Resultados: Foram incluídos 50 pacientes (30 do sexo masculino), com média de idade de 58,3 ± 13,5 anos. Foram realizadas 201 punções em 81 linfonodos ou massas mediastinais (média de 2,5 punções). O material obtido foi considerado adequado para análise citológica em 37 pacientes (74%), dos quais 21 (57%) foram diagnosticados com malignidade. Nos 16 pacientes remanescentes, 1 teve diagnóstico de tuberculose, 6 tiveram seguimento clínico, e 9 foram submetidos a investigação adicional...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

et al. 2012

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“…We believe that this optimal goal can be achieved with the effective use of EBUS- Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively new and minimally invasive procedure for sampling mediastinal and hilar lymph nodes. [1][2][3][4][5][6][7][8][9][10] In the mid 1990s, EBUS-TBNA described the use of a 20 MHz radial ultrasound probe to identify lymph nodes and guide sampling of peripheral lung lesions. The ultrasound probe was then removed, and the lymph node punctured in the standard manner.…”

mentioning

confidence: 99%

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

Feller‐Kopman

Yung

Burroughs

et al. 2009

Cancer Cytopathology

103

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BACKGROUND:Endobronchial ultrasound (EBUS) is a relatively new modality that can be used to guide transbronchial needle aspiration (TBNA) of mediastinal and hilar lymph nodes and peripheral lung lesions. Few studies have investigated the cytological profile of EBUS‐TBNA specimens. In this study, we have reviewed the cytological profile of 135 consecutive cases, including 71 lymph node cases, 4 lung cases, and 60 cases of both lymph node and lung sampling. Our study contains the largest number of cases in the evaluation of cytomorphology.METHODS:The cytological specimens were collected using an ultrasound bronchofibervideoscope with a 22‐gauge needle and core biopsies were obtained with a 19‐gauge needle. An experienced cytotechnologist performed an immediate on‐site evaluation of adequacy. An immediate assessment was given to the clinician after each pass. In many patients, multiple sites were sampled. The average slides of each case were 9.9 (median of 12), with a range from 2 to 24.RESULTS:Of 131 cases of lymph node sampling, 45 cases (34.6%) were diagnosed as malignant, 73 cases (55.7%) as benign process, 5 cases (3.8%) as suspicious for malignancy, and 1 case (0.8%) as atypical cells. Of the 64 cases of lung lesion sampling, 21 cases (32.8%) were diagnosed as malignant, 35 cases (54.7%) as benign process, 1 case (1.5%) as suspicious for malignancy, and 4 cases (6.3%) as atypical cells. The lymph node nondiagnostic rate was 5.3%, whereas the nondiagnostic rate for lung lesions was 4.7%. Eighty‐eight cases (65.2%, 88/135) had corresponding core biopsies (with a 19‐gauge needle) or follow‐up surgery. When histology was taken as the gold standard, the sensitivity, specificity, and positive and negative predictive values for EBUS‐TBNA were 85.0%, 100%, and 100% and 89.7%, respectively. However, when both histology and clinical follow‐up were considered together, the overall sensitivity and negative predictive values were increased to 94.7% (P < .05) and 96.6% (P < .05), respectively.CONCLUSIONS:This study shows that EBUS‐TBNA is an accurate and sensitive method for diagnosing and staging lung cancer. The constant challenge that we as cytopathologists are now facing is how to improve our diagnostic ability and accuracy for lung cancer. We believe that this optimal goal can be achieved with the effective use of EBUS‐TBNA sampling and collaboration with our clinical colleagues. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

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“…Studies have shown the learning curve for EBUS‐TBNA to be variable, ranging from 10 to 50 procedures before reaching peak sensitivity, and that improvement can still be seen after more than 200 cases 11, 12, 13, 14, 15…”

Section: Introductionmentioning

confidence: 99%

Influence of trainee involvement on procedural characteristics for linear endobronchial ultrasound

et al. 2017

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BackgroundLinear endobronchial ultrasound (EBUS) is a safe and effective method for the diagnostic sampling of mediastinal lymph nodes. However, there is a learning curve associated with the procedure and operator experience influences diagnostic yield. We sought to determine if trainee involvement during EBUS influences procedural characteristics, complication rate, and diagnostic yield.MethodsWe performed a retrospective analysis of 220 subjects who underwent an EBUS procedure at our center from December 2012 to June 2013. Procedures were performed by six different interventional pulmonologists with substantial experience with EBUS or by a trainee under their direct supervision. Procedural characteristics and complications were recorded. Diagnostic yield and specimen adequacy were compared between groups.Results EBUS was performed in 220 patients with a trainee involved (n = 116) or by staff physician alone (n = 104). Patient characteristics, and the number and size of lymph node stations sampled were similar. EBUS duration was longer (16.0 vs. 13.7 minutes; P = 0.002) and the total dose of lidocaine used was higher (322.3 vs. 304.2 mg; P = 0.045) when a trainee was involved. The rate of adequate specimens sampled was comparable between the groups (92.0 vs. 92.0%; P = 0.60). Diagnostic yield was lower when a trainee was involved in the EBUS procedure (52.6 vs. 68.3%; P = 0.02).ConclusionTrainee involvement significantly increased EBUS duration and the dose of local anesthesia used for the procedure. Diagnostic yield was lower when a trainee was involved. Factors accounting for this difference in yield, despite adequate samples being obtained, warrant further investigation.

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Endobronchial Ultrasound-Guided Fine-Needle Aspiration of Mediastinal Lymph Nodes: A Single Institution's Early Learning Curve

Cited by 96 publications

References 38 publications

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

Influence of trainee involvement on procedural characteristics for linear endobronchial ultrasound

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