Original Article

Endobronchial Ultrasound Transbronchial Needle Aspiration in Mediastinal and Hilar Lymphadenopathies

Authors: Fayez Kheir, MD, Jaime Palomino, MD

Abstract

Objectives: Endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) is a relatively noninvasive technique that allows sampling of mediastinal and hilar lymph nodes or masses under real-time and direct visualization, overcoming some of the problems associated with mediastinoscopy and blind TBNA. The goal of this study was to evaluate the yield of this technique in patients with and without malignant disease in a newly started EBUS program involving physicians not previously fully trained in interventional pulmonology.


Methods: Between March 2010 and July 2011, 43 patients with enlarged lymph nodes (>1 cm on short axis) on chest computed tomography who underwent EBUS-TBNA were included in the study. Nondiagnostic results were confirmed with mediastinoscopy. The sensitivity, specificity, positive predictive value and negative predictive value of the technique were assessed.


Results: Among the 43 patients who underwent EBUS-TBNA, a correct diagnosis was made in 39 of the 43 patients (91%). The sensitivity, specificity, positive predictive value, and negative predictive values were 89%, 100%, 100%, and 67%, respectively. The success rate, complication rate, and 30-day mortality were 91%, 0%, and 0%, respectively.


Conclusions: EBUS-TBNA is a safe and effective approach with high diagnostic yield and minimal complications for diagnosing and staging of mediastinal/hilar lymph nodes. Satisfactory results can be obtained immediately by pulmonologists experienced in conventional bronchoscopy with the provision of additional training on the technique.

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References

1. Hürter T, Hanrath P. Endobronchial sonography: feasibility and preliminary results. Thorax 1992; 47: 565–567.
 
2. Rusch VW, Asamura H, Watanabe H, et al. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming 7th edition of the TNM classification for lung cancer. J Thorac Oncol 2009; 4: 568–577.
 
3. Yasufuku K, Nakajima T, Motoori K, et al. Comparison of endobronchial ultrasound, positron emission tomography and CT for lymph node staging of lung cancer. Chest 2006; 130: 710–718.
 
4. Herth FJ, Ernst A, Eberhardt R, et al. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. Eur Respir J 2006; 28: 910–914.
 
5. Yasufuku K, Nakajima T, Fujiwara T, et al. Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer. Gen Thorac Cardiovasc Surg 2008; 56: 268–276.
 
6. Herth FJ, Eberhardt R, Vilmann P, et al. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax 2006; 61: 795–798.
 
7. Cerfolio RJ, Bryant AS, Eloubeidi MA, et al. The true false negative rates of esophageal and endobronchial ultrasound in the staging of mediastinal lymph nodes in patients with non-small cell lung cancer. Ann Thorac Surg 2010; 90: 427–434.
 
8. Herth F, Becker HD, Ernst A. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial. Chest 2004; 125: 322–325.
 
9. Yasufuku K, Chiyo M, Koh E, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer 2005; 50: 347–354.
 
10. Ernst A, Anantham D, Eberhardt R, et al. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. J Thorac Oncol 2008; 3: 577–582.
 
11. Annema JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA 2010; 304: 2245–2252.
 
12. Yasufuku K, Nakajima T, Chiyo M, et al. Endobronchial ultrasonography: current status and future directions. J Thorac Oncol 2007; 2: 970–979.
 
13. Irani S, Hess T, Hofer M, et al. Endobronchial ultrasonography for the quantitative assessment of bronchial mural structures in lung transplant recipients. Chest 2006; 129: 349–355.
 
14. Ømark Petersen H, Eckardt J, Hakami A, et al. The value of mediastinal staging with endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer. Eur J Cardiothorac Surg2009; 36: 465–468.
 
15. Groth SS, Whitson BA, D’Cunha J, et al. Endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes: a single institution’s early learning curve. Ann Thorac Surg 2008; 86: 1104–1110.
 
16. Ost DE, Ernst A, Lei X, et al. Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry. Chest 2011; 140: 1557–1566.
 
17. Nakajima T, Yasufuku K, Takahashi R, et al. Comparison of 21-gauge and 22-gauge aspiration needle during endobronchial ultrasound-guided transbronchial needle aspiration. Respirology 2011; 16: 90–94.
 
18. Sun JY, Zhao H, Zhang J, et al. First 30 endobronchial ultrasound-guided transbronchial needle aspirations: a single institution’s early experience. Chin Med J (Engl) 2011; 124: 1818–1823.
 
19. Bizekis CS, Santo TJ, Parker KL, et al. Initial experience with endobronchial ultrasound in View Full Text | PubMed | CrossRef
 
20. Gu P, Zhao YZ, Jiang LY, et al.. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. Eur J Cancer 2009; 45: 1389–1396.