Thoracic endosonography (EBUS/EUS‐b) in the diagnosis of different intrathoracic diseases: A 4‐year experience at a single‐centre in Greece

Abstract

Background In the last decade, the advent of thoracic endosonography has revolutionised the field of diagnostic bronchoscopy. Methods We conducted a single‐centre prospective study in “Sotiria” Chest diseases hospital between January 2016 and December 2019. The study aimed to evaluate the efficacy and diagnostic value of combined EBUS/EUS‐b in comparison with EBUS‐TBNA and EUS‐b FNA in different intrathoracic diseases. Results A total of 266 patients were enrolled (70.7% males, 85.7% smokers, mean age ± SD: 62.8 ± 11.8). Diagnosis and staging of suspected lung cancer (LC) were the main indications for EBUS/EUS‐b in 56.7% of patients, followed by lymphadenopathy of unknown origin in 27%, lymphadenopathy in previous malignancy in 10.9%, and staging of proven LC in 5.3%. EUS‐b FNA alone or combined with EBUS‐TBNA was performed in 14.7% of patients. A total of 512 lymph nodes was sampled (481 through EBUS‐TBNA and 31 through EUS‐b FNA). EBUS/EUS‐b led to a definitive diagnosis in 68.4% of the patients. Most cases (50.4%) were malignancies, while 18% represented benign diseases (83.3% sarcoidosis). Sensitivity of combined EBUS/EUS‐b was higher in comparison with sensitivity of both procedures alone (100% vs 89.4% vs 88.9%). Accordingly, the overall sensitivity of EBUS/EUS‐b for the detection of malignancy and sarcoidosis was 93% and 95.2%, respectively. No severe complications were observed. Conclusion Thoracic endosonography is an efficient, safe, minimally invasive tool yielding high sensitivity and diagnostic accuracy in patients with suspected malignancy and mediastinal lymphadenopathy. Experienced pulmonologists in EBUS‐TBNA should more routinely perform EUS‐b FNA to avoid unnecessary surgical interventions.

Diagnostic and Therapeutic Challenges for Patients with Idiopathic Pulmonary Fibrosis and Lung Cancer

“…On the contrary, agreement rates were considerably decreased in cases of severe IPF 19 . However, EBUS-TBNA/B in centers of expertise seems to be a safe procedure and maybe even safer than bronchoalveolar lavage 36,37 . Thus, patients with acceptable performance status might experience benefit from timely diagnostic interventions.…”

Management of patients with idiopathic pulmonary fibrosis and lung cancer: challenges in clinical practice

“…Contrary to patients with mild-to-moderate IPF, level of agreement was lower for patients with severe IPF [17]. However, complications of EBUS-TBNB in specialized centers are rare and EBUS-TBNB might be safer compared with bronchoalveolar lavage [55,56]. Thus, patients with IPF and good performance status (ECOG: 1-2) could benefit from timely diagnosis and interventions.…”

Interventional Pulmonology and Esophagus: Combined Endobronchial Ultrasound and Endoscopic Ultrasound for Mediastinal Staging

“…36 In a prospective trial, combined EBUS/EUS-FNA in the radiologically normal mediastinum had a diagnostic sensitivity of 68%, positive predictive value (PPV) of 98%, and negative predictive value (NPV) of 91%. 37 In a radiologically normal mediastinum, surgical exploration is not indicated if the results of combined EBUS/EUS are negative. Combined EBUS and EUS has been found to be more accurate in detection of occult metastases in patients with radiologically normal mediastinum with one study showing that combined EBUS/EUS led to upstaging of 13% of patients to the discovery of occult metastases in 22% of patients.…”