Transesophageal Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) Biopsy: a Combined Approach in the Evaluation of Mediastinal Lesions

Vilmann, Peter; Krasnik, Mark; Larsen, Soeren S.; Jacobsen, G. K.; Clementsen, Paul Frost

doi:10.1055/s-2005-870276

Cited by 273 publications

(179 citation statements)

References 12 publications

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“…As reported in previous studies, there is no difference in yield or patient tolerance if the procedure is performed under moderate sedation or general anaesthesia [24]. Depending on the lymph node localisation, EBUS-TBNA seems at least comparable to the established EUS-FNA findings in the literature [15,27,28]. It is important to note that small lymph nodes are more difficult to identify with any imaging modality (including EBUS) and probably contain a small number of malignant cells, making a cytological diagnosis difficult.…”

Section: Discussionsupporting

confidence: 56%

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Herth

Ernst²,

Eberhardt³

et al. 2006

Eur Respir J

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281

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes f1 cm in diameter.NSCLC patients with CT scans showing no enlarged lymph nodes (no node .1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results.In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred.In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.

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Section: Discussionsupporting

confidence: 56%

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Herth

Ernst²,

Eberhardt³

et al. 2006

Eur Respir J

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281

161

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“…The majority of studies do not differentiate between these subgroups and this is an important drawback. Even though the current authors could find no observable differences in studies that exclusively enrolled patients with NSCLC [12,13,15,17] or that primarily analyse mediastinal and hilar metastasis [9,13,17,20] in comparison to those that include only patients with mediastinal metastases [12,18,24], additional studies are required to clarify the effectiveness of this test in different clinical situations.…”

Section: Generalisability Of the Published Resultsmentioning

confidence: 65%

“…EUS-FNA is a complementary technique that enables visualisation of posterior nodes not visualised by EBUS-TBNA but does not allow the visualisation of the anterior mediastinum [13,19]. Two studies [19,24] support the theory that the combination of EBUS-TBNA and EUS-FNA could dispense with surgical techniques in the great majority of cases, but one of these studies includes only 20 patients [20] and the validity of both is diminished due to the lack of confirmation of all negative results using reference techniques such as mediastinoscopy and/or thoracoscopy. Additionally, WALLACE et al [19] used lymph nodes, instead of patients, as the unit of analysis, so the possibility that study results are inflated cannot be dismissed [34].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of endobronchial ultrasound–transbronchial needle aspiration: a systematic review

2009

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The aim of the present systematic review was to assess the effectiveness and safety of real time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with suspected or known bronchopulmonary carcinoma, as well as in other clinical indications presented by lymphatic adenopathies.A systematic review was carried out in November 2007 and updated in April 2008 using the main databases. Inclusion and exclusion criteria were applied to the papers retrieved.A total of 20 publications were included. Of these, 14 were original studies that investigated the clinical usefulness of the technique in visualising and staging lymph nodes in patients with suspected or established lung cancer. Sensitivity ranged 85-100% and negative predictive value ranged 11-97.4%. Three studies assessed the clinical usefulness of the technique in the diagnosis of sarcoidosis. EBUS-TBNA was diagnostic in 88-93% of patients. One retrospective study evaluated the use of EBUS-TBNA in the diagnosis of lymphoma. None of the studies included in the present review reported important complications.Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and highly accurate procedure for the examination and staging of mediastinal and hilar lymph nodes in patients with known or suspected lung malignancy. The evidence is promising for sarcoidosis but is not sufficient for lymphoma.

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“…Among them, EBUS-TBNA has been shown to be a safer, more sensitive, and cost effective diagnostic procedure. [1][2][3][4][5][6][7][8][9][10][11][12]14,17,18 Clinical studies have shown that EBUS-TBNA has sensitivity, specificity, and positive and negative predictive values of 84%-100%, 100%, and 100% and 67%-97%, respectively. [6][7][8][9]16,18 The optimal use of EBUS-TBNA depends on the effective collaboration between the cytopathologist and the endoscopist.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] Studies have also shown that EBUS-TBNA has a higher sensitivity and specificity than mediastinoscopy, EUS, and conventional TBNA in staging and diagnosing lung lesions. 3,4,5,13,14,16,17 Several types of specimens can be obtained with EBUS guidance, including needle aspiration, brushing, washing, lavage, and core needle biopsy. 4,6,7,19 Direct smears can be made from needle aspiration and brushing specimens to allow on-site evaluation.…”

Section: -10mentioning

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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Transesophageal Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) Biopsy: a Combined Approach in the Evaluation of Mediastinal Lesions

Cited by 273 publications

References 12 publications

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Effectiveness and safety of endobronchial ultrasound–transbronchial needle aspiration: a systematic review

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

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