Endobronchial ultrasound‐guided transbronchial needle aspiration: Onwards and upwards

Medford, Andrew R L

doi:10.1111/j.1759-7714.2011.00065.x

Cited by 4 publications

(3 citation statements)

References 40 publications

(39 reference statements)

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“…For tariff‐based health care systems, it is crucial that EBUS‐TBNA tariffs recognise this innovation. In the UK until recent times, there was no specific EBUS‐TBNA tariff, so that EBUS‐TBNA received a standard flexible bronchoscopy tariff despite the increased cost, complexity and time of the procedure (50,51). Coding errors remain commonplace and also contribute to revenue loss (43,52,53).…”

Section: Cost Issuesmentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration

Medford

2010

International Journal of Clinical Practice

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Summary Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a minimally invasive mediastinal staging tool for lung cancer but also a diagnostic tool for mediastinal lesions near the airway. After a brief historic rationale, this article reviews the indications for EBUS‐TBNA, provides an overview of practical, training and financial issues; reviews the evidence comparing the mediastinal staging tools and briefly discusses potential future applications. EBUS‐TBNA is most commonly used for staging non‐small cell lung cancer (NSCLC), but is also used for diagnosis of unexplained mediastinal lymphadenopathy of other causes. For staging before radical treatment, many centres still perform mediastinoscopy and this should be done to confirm negative EBUS‐TBNA results in this setting and when the pre‐test clinical probability of lung cancer is high. EBUS‐TBNA may be used in the future for staging when the mediastinal nodes are normal according to radiological staging and also in re‐staging. EBUS‐TBNA can be learned with appropriate training and mentorship; it offers numerous advantages over mediastinoscopy; and it is less invasive and can reduce costs by avoiding unnecessary mediastinoscopies in many cases.

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Section: Cost Issuesmentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration

Medford

2010

International Journal of Clinical Practice

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“…EBUS requires extra training beyond conventional bronchoscopy. The price and running costs is still higher than mediastinoscopies [30].…”

Section: Discussionmentioning

confidence: 99%

Fiber-optic bronchoscope and detection of lung cancer: A five year study

Gao

Asmitanand²,

Ren³

et al. 2012

neo

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White light bronchoscopy [WLB] has been used for identification and localization of intra-epithelial pre-neoplastic and neoplastic lesions within the bronchus. Aim of the study was to evaluate the uses of WLB to detect and localize the precancerous and cancerous lesions, and in addition to analyze morphologic presentation, and association to histological type and the variation between genders.A total of 4983 patients were examined by WLB from 2004 to 2009 in a local tertiary teaching hospital. The following parameters were collected: morphological presentation, biopsy sites, histology. The patients' records of age, sex, smoking status, blood-gas, X-RAY/CT, CBC, ECG, PT, and APTT were obtained for analysis. Differences between the patients groups were analyzed using Chi square test.1489 patients who had hyperplasia or neoplasic lesions were further confirmed as having lung cancer pathologically. Lung cancer was more commonly found in the right lung (51.58% vs 42.82%). The upper lobe was more frequently found to have lesions (44.17% vs 22.42%) than the lower lobe. Male patients with squamous cell carcinoma showed more commonly upper lobe involvement, while left main bronchus was more commonly involved in female patients. Adenocarcinoma was mostly involved in lesions of the upper lobe. Proliferative type was found in 80.15% of squamous cell carcinoma cases and in 76.16 % of small cell carcinoma cases.Fiberoptic bronchoscopy is an effective method for the detection of preinvasive neoplasic lesions. The morphological presentation is associated to histological type. There is variation in presentation and histology of cancerous lung lesion between the genders.

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“…Firstly, it is imperative that the tariffs are updated in line with innovation—for example, in the UK there is no specific EBUS-TBNA tariff which is not sufficiently distinguished from a standard flexible bronchoscopy tariff despite the increased cost, complexity and time of EBUS-TBNA 65 66. Secondly, correct procedure coding remains pivotal as exemplified by studies and reports showing significant rates of coding error in the UK health care system 67–69…”

Section: Financial Issuesmentioning

confidence: 99%

Endobronchial ultrasound guided transbronchial needle aspiration

Medford

Bennett

Free

et al. 2010

Postgraduate Medical Journal

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Staging for non-small cell lung cancer (NSCLC) requires accurate assessment of the mediastinal lymph nodes which determines treatment and outcome. As radiological staging is limited by its specificity and sensitivity, it is necessary to sample the mediastinal nodes. Traditionally, mediastinoscopy has been used for evaluation of the mediastinum especially when radical treatment is contemplated, although conventional transbronchial needle aspiration (TBNA) has also been used in other situations for staging and diagnostic purposes. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive alternative to mediastinoscopy with additional access to the hilar nodes, a better safety profile, and it removes the costs and hazards of theatre time and general anaesthesia with comparable sensitivity, although the negative predictive value of mediastinoscopy (and sample size) is greater. EBUS-TBNA also obtains larger samples than conventional TBNA, has superior performance and theoretically is safer, allowing real-time sampling under direct vision. It can also have predictive value both in sonographic appearance of the nodes and histological characteristics. EBUS-TBNA is therefore indicated for NSCLC staging, diagnosis of lung cancer when there is no endobronchial lesion, and diagnosis of both benign (especially tuberculosis and sarcoidosis) and malignant mediastinal lesions. The procedure is different than for flexible bronchoscopy, takes longer, and requires more training. EBUS-TBNA is more expensive than conventional TBNA but can save costs by reducing the number of more costly mediastinoscopies. Revenue based tariff systems have been slow to reflect the innovation of techniques such as EBUS-TBNA. In the future, endobronchial ultrasound may have applications in airways disease and pulmonary vascular disease.

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Endobronchial ultrasound‐guided transbronchial needle aspiration: Onwards and upwards

Cited by 4 publications

References 40 publications

Endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration

Fiber-optic bronchoscope and detection of lung cancer: A five year study

Endobronchial ultrasound guided transbronchial needle aspiration

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Endobronchial ultrasound‐guided transbronchial needle aspiration: Onwards and upwards

Cited by 4 publications

References 40 publications

Endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration

Fiber-optic bronchoscope and detection of lung cancer: A five year study

Endobronchial ultrasound guided transbronchial needle aspiration

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Fiber-optic bronchoscope and detection of lung cancer: A five year study