IMPLEMENTING EBUS TBNA: FIRST EXPERIENCE AND REVIEW OF LITERATURE

Authors

  • F. RUSU-CORDUNEAN University of Medicine and Pharmacy “Gr. T. Popa”, Iasi
  • A.T. CERNOMAZ University of Medicine and Pharmacy “Gr. T. Popa”, Iasi
  • Madalina Lavinia BERLEA University of Medicine and Pharmacy “Gr. T. Popa”, Iasi
  • D. FERARIU Regional Institute of Oncology, Iasi
  • B.D. GRIGORIU University of Medicine and Pharmacy “Gr. T. Popa”, Iasi

Abstract

Lung cancer has a very dismal prognosis and careful diagnosis and staging is of outmost importance. EBUS has become a cornerstone investigation for diagnosis and staging and current guidelines stress that there is a steep learning curve when introducing this technique in practice (only 30 procedures are considered necessary). Over a period of 10 months a total of 21 patients have been addressed to our unit for an EBUS TBNA procedure. Only three were referred for staging purposes (for lung, digestive and cervix cancers) the others being primary diagnostic approaches where simpler procedures had previously failed. Procedures were initially performed under local anesthesia (3 cases) then under general anesthesia and jet ventilation using a laryngeal mask approach. Mediastinal lymph node group 7 was the most frequent target (9 cases) followed by group 4R (8 cases) and peribronchial tumoral processes (7 cases); one case did not required any needle-aspiration. On average each examination resulted in the sampling of 1.4 targets. There were no significant procedure related severe adverse events. Although 21 G cytology needles were used, adequate histological samples were obtained for 11 cases and cytology was the examination of choice for 9 cases. The pathology/cytology results were retrospectively assessed as satisfactory for 15 cases (confirmed neoplastic or other disease) and inconclusive for 5 cases. Non neoplastic disorders were represented by sarcoidosis, tuberculosis and bronchogenic cyst (3 cases). The procedure can be considered fast and safe; trained pathology personnel play an extremely important role; presently referrals are rare for staging purposes.

Author Biographies

  • F. RUSU-CORDUNEAN, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi

    Faculty of Medicine
    Department of Medical Specilities (II)

  • A.T. CERNOMAZ, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi

    Faculty of Medicine
    Department of Medical Specilities (II)
    Regional Institute of Oncology, Iasi
    Pneumology Compartment

  • Madalina Lavinia BERLEA, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi

    Faculty of Medicine
    Department of Medical Specilities (II)
    Regional Institute of Oncology, Iasi, 
    Pneumology Compartment

  • D. FERARIU, Regional Institute of Oncology, Iasi

    Pathology Department

  • B.D. GRIGORIU, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi

    Faculty of Medicine
    Department of Medical Specilities (II)
    Regional Institute of Oncology, Iasi, 
    Pneumology Compartment

References

1. Toloza, E.M., L. Harpole, and D.C. McCrory, Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003; 123(1 Suppl): 137S-146S.
2. Cerfolio, R.J., et al., The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer. Ann Thorac Surg 2004; 78(3): 1017-23; discussion 1017-1023.
3. Meyers, B.F., et al., Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stage I lung cancer. J Thorac Cardiovasc Surg 2006; 131(4): 822-829
4. Harken, D.E., et al., A simple cervicomediastinal exploration for tissue diagnosis of intrathoracic disease; with comments on the recognition of inoperable carcinoma of the lung. N Engl J Med 1954; 251(26): 1041-1044.
5. Adams, K., et al., Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax, 2009; 64(9): 757-762.
6. Micames, C.G., et al., Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis. Chest, 2007; 131(2): 539-48.
7. Annema, J.T., et al., Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA 2010; 304(20): 2245-2252.
8. Zhang, R., et al., Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis. Eur J Cancer, 2013. 49(8): 1860-1867.
9. von Bartheld, M.B., K.F. Rabe, and J.T. Annema, Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes. Gastrointest Endosc 2009; 69(2): 345-349.
10. Tournoy, K.G., et al., Endoscopic ultrasound reduces surgical mediastinal staging in lung cancer: a randomized trial. Am J Respir Crit Care Med 2008; 177(5): 531-535.
11. Casal, R.F., et al., The use of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of thyroid lesions. BMC Endocr Disord 2014; 14: 88.

12. Jhun, B.W., et al., Clinical value of endobronchial ultrasound findings for predicting nodal metastasis in patients with suspected lymphadenopathy: a prospective study. J Korean Med Sci, 2014; 29(12): 1632-1638.
13. Oezkan, F., et al., Efficient utilization of EBUS-TBNA samples for both diagnosis and molecular analyses. Onco Targets Ther 2014; 7: 2061-2065.
14. Bellinger, C.R., et al., Training in and Experience with Endobronchial Ultrasound. Respiration, 2014. 88(6): 478-483.
15. Cerfolio, R.J. and A.S. Bryant, Ratio of the maximum standardized uptake value on FDG-PET of the mediastinal (N2) lymph nodes to the primary tumor may be a universal predictor of nodal malignancy in patients with nonsmall-cell lung cancer. Ann Thorac Surg, 2007. 83(5): 1826-9; discussion 1829-30.
16. van der Heijden, E.H., et al., Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer. Respiration 2014; 88(6): 500-517.
17. Block, M.I., Endobronchial ultrasound for lung cancer staging: how many stations should be sampled? Ann Thorac Surg 2010; 89(5): 1582-1587.
18. Cordovilla, R., A.M. Torracchi, and M.C. Garcia-Macias, Enhancement of conventional TBNA outcome after EBUS Training. J Bronchology Interv Pulmonol 2014; 21(4): 322-326.
19. Shirakawa, T., et al., Usefulness of endobronchial ultrasonography for transbronchial lung biopsies of peripheral lung lesions. Respiration 2004; 71(3): 260-268.
20. Eapen, G.A., et al., Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry. Chest 2013; 143(4): 1044-1053.
21. Evison, M., et al., A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA. BMJ Open Respir Res 2014; 1(1): e000040.
22. Karunamurthy, A., et al., Evaluation of endobronchial ultrasound-guided fine-needle aspirations (EBUS-FNA): correlation with adequacy and histologic follow-up. Cancer Cytopathol 2014; 122(1): 23-32.
23. Collins, B.T., Endobronchial ultrasound fine-needle aspiration biopsy of pulmonary non-small cell carcinoma with subclassification by immunohistochemistry panel. Cancer Cytopathol 2013; 121(3): 146-154.
24. Li, K. and S. Jiang, A randomized controlled study of conventional TBNA versus EBUS-TBNA for diagnosis of suspected stage I and II sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31(3): 211-218.
25. Goyal, A., et al., Value of different bronchoscopic sampling techniques in diagnosis of sarcoidosis: a prospective study of 151 patients. J Bronchology Interv Pulmonol 2014; 21(3): 220-226.
26. Ozgul, M.A., et al., Lymph node characteristics of sarcoidosis with endobronchial ultrasound. Endosc Ultrasound 2014; 3(4): 232-237.

Additional Files

Published

2015-03-31

Issue

Section

INTERNAL MEDICINE - PEDIATRICS