Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Technical Updates and Pathological Yield

Abstract

Since the endobronchial ultrasound bronchoscope was introduced to clinical practice, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the procedure of choice to sample hilar and mediastinal adenopathy. Multiple studies have been conducted in the last two decades to look at the different technical aspects of the procedure and their effects on the final cytopathological yield. In addition, newer modes of ultrasound scanning and newer tools with the potential to optimize the selection and sampling of the target lymph node have been introduced. These have the potential to reduce the number of passes, reduce the procedure time, and increase the diagnostic yield, especially in rare tumors and benign diseases. Herein, we review the latest updates related to the technical aspects of EBUS-TBNA and their effects on the final cytopathological yield in malignant and benign diseases.

Real time endobronchial ultrasound transbronchial needle aspiration for the diagnosis of tuberculous intrathoracic lymphadenopathy

“…12,[17][18][19] The role of EBUS-TBNA has shown sustained growth over the past 2 decades, from its earlier use in lung cancer staging and evaluation of lesions in the mediastinum to a more extensive utility in the diagnosis of intrathoracic lymphadenopathy. [10][11]18 The EBUS-TBNA sampling carried out among the study patients was adequate in 96.8% of the procedures. Previous studies among patients with intrathoracic lymphadenopathy who had clinical symptoms and signs suggestive of TB or sarcoidosis indicate that sample adequacy from EBUS-TBNA ranged from 89 to 98%.…”

“…[10][11] Among individuals having lung cancer or sarcoidosis, EBUS-TBNA has demonstrated higher yield and sensitivity when compared to conventional TBNA or mediastinoscopy. [10][11] Some studies have assessed the importance of EBUS-TBNA during the evaluation of individuals having suspected INTBLA and reported sensitivity rates of 59.3 to 94.0%. [12][13][14][15] There is no data on the usefulness of EBUS-TBNA in the assessment of suspected INTBLA in Saudi Arabia whereas TB burden is relatively low.…”

“…In a study of 315 suspected TB patients who underwent EBUS-TBNA in the United Kingdom, the culture rate was 35%; 15 25 The low culture rates for Mycobacterium tuberculosis observed may likely be due to variation in the bacillary load of persons with INTBLA; however, the culture rate reported using EBUS-TBNA samples are consistent with the rates gotten with other diagnostic modalities. [10][11] Further research are needed to evaluate the benefits, if any, of immediate inoculation of the TBNA samples in the TB culture medium. The potential benefits of carrying out rapid molecular techniques, like Xpert MTB/RIF or CB-NAAT system using TBNA samples in order to improve their diagnostic sensitivity deserves further investigation.…”

“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is meritorious for being able to reach most of the intrathorcic lymph nodes under the guidance of ultrasonography – even nodes below 10 mm in diameter, and the procedure-related complications are very small compared to conventional TBNA or mediastinoscopy. 10 - 11 Among individuals having lung cancer or sarcoidosis, EBUS-TBNA has demonstrated higher yield and sensitivity when compared to conventional TBNA or mediastinoscopy. 10 - 11 Some studies have assessed the importance of EBUS-TBNA during the evaluation of individuals having suspected INTBLA and reported sensitivity rates of 59.3 to 94.0%.…”

Application of endobronchial ultrasound-guided needle aspiration biopsy combined with T cell spot test for granulomas lesion in mediastinal-hilar lymph nodes

“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technical innovation in the diagnosis of mediastinal-hilar lymph node lesions. EBUS-TBNA combines the advantages of the miniature ultrasound probe and ordinary optical ber bronchoscopy, scanning and puncturing the trachea or bronchial lumen by real-time ultrasound (5).…”