Endobronchial ultrasound: Practical aspects and clinical applications

Bugalho, António; Doris, Michael K; Hamacher, Juerg; Eberhardt, Ralf; Herth, Felix J.F.

doi:10.1016/s2173-5115(09)70244-1

Cited by 5 publications

(3 citation statements)

References 60 publications

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“…The type of sedation used during EBUS-TBNA is also extremely important, because it can affect the diagnostic accuracy, procedure safety, and patient comfort, and at same time determines the need for additional health-care resources and increased care costs. A guideline and panel report of experts suggest that moderate or deep sedation are acceptable approaches during EBUS-TBNA [ 5 ], but the poor quality of the published studies has resulted in a weak recommendation (grade 2C) [ 6 ]. In addition, sedation protocols are quite variable across institutions and are usually based on individual parameters, local resources, and operator preferences.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, sedation protocols are quite variable across institutions and are usually based on individual parameters, local resources, and operator preferences. Initial studies were done under general anesthesia [ 5 ], but recently, several centers have started using moderate or deep sedation. In fact, studies conducted to evaluate and compare different sedation levels during EBUS-TBNA have shown conflicting results [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia

Fernandes

Santos

Martins

et al. 2018

JCM

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Background: Different anesthetic protocols may influence endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) outcomes, patient comfort, and even safety. In this study, two anesthesia techniques were assessed and compared for EBUS-TBNA. Methods: A prospective, multicenter study was carried out. Patients were allocated to Group 1 (general anesthesia with neuromuscular blockade and controlled ventilation) and Group 2 (intravenous sedation). EBUS-TBNA accuracy was the primary outcome. Safety, patient comfort and satisfaction, and operators’ difficulties were defined as secondary outcomes. Results: Of the 115 patients enrolled (Group 1 = 59, Group 2 = 56), EBUS-TBNA was performed for hilar or mediastinal lesion diagnosis and lung cancer staging in, respectively, 77 (67%) and 38 (33%) patients. The numbers of lymph nodes stations (1.8 ± 1.0 vs. 1.7 ± 1.0, p = 0.472) and punctures per station (6.9 ± 3.1 vs. 6.0 ± 2.5, p = 0.084) were similar between groups. Adequate samples were obtained from 109 patients (97.3%) with similar diagnostic accuracy. Procedure duration was not significantly different (p = 0.348). Hemodynamic parameters and systolic and diastolic blood pressures were higher in Group 1 at the beginning and at the end of the procedure. Adverse events were equally distributed, and no significant differences were found regarding patient satisfaction and bronchoscopist/anesthesiologist difficulties. Conclusions: The type of anesthesia used did not influence EBUS-TBNA outcomes. EBUS-TBNA performed under sedation or general anesthesia did not affect the diagnostic yield, complication rate, and patients’ comfort and satisfaction.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia

Fernandes

Santos

Martins

et al. 2018

JCM

Self Cite

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“…A flexible ultrasound scope (BF-UC206F-OL8, Olympus) was guided towards the targeted lymph nodes, and these were visualized on ultrasound [13]. Lymph nodes were classified according to the seventh TNM staging system [14].…”

Section: Patients and Specimen Collectionmentioning

confidence: 99%

Immature myeloid cells and tolerogenic cytokine profile in lung adenocarcinoma metastatic lymph nodes assessed by endobronchial ultrasound

et al. 2015

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In lung cancer, the immune cell compartment of tumor-draining lymph nodes (TDLNs) dictate the response against tumors. This response is predominantly triggered by myeloid antigen-presenting cells (mAPCs) that capture antigens and, if matured, prime anti-tumor-specific T cell populations. However, the clinical role of mAPCs infiltrated in TDLN from lung cancer patients is poorly understood. The purpose of this study was to study mAPCs in TDLN from lung adenocarcinoma patients, in comparison to individuals with non-malignant diseases, using minimally invasive sampling methods. Mediastinal lymph nodes were assessed by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). mAPCs were characterized by flow cytometry and cytokine expression by quantitative polymerase chain reaction. The association with tumor burden, overall survival, and response to treatment was assessed. TDLN from lung adenocarcinoma patients (n = 24) showed a reduced immune cell compartment, but a higher level of infiltrating mAPCs, when compared with control lymph nodes (n = 17). A decreased expression of co-stimulatory molecules CD80/CD86 by TDLN and blood mAPC was observed. TDLN showed lower levels of TNF-α and IL-12 and increased levels of immunosuppressive cytokines TGF-β and IL-10. The IL-12 expression was inversely correlated with the percentage of infiltrated tumor cells, while IL-10 was directly correlated. Patients with lower expression of IL-12 in TDLN or lower expression of CD80/86 in blood mAPCs had worse overall survival and response to therapy. mAPCs of lung adenocarcinoma patients express less co-stimulatory molecules, and within TDLN, the cytokine profile is biased towards a tolerance-inducing phenotype. Patients with enhanced immune parameters have better survival and response to treatment. EBUS-TBNA allows the collection of viable specimens from TDLN that may provide further insight on relevant immunological mechanisms.

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