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The role of convex probe endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of malignant mediastinal and hilar lymph nodes.

Caglayan B, Salepci B, Dogusoy I, Fidan A, Sener Comert S, Kiral N, Yavuzer D, Sarac G - Iran J Radiol (2012)

Bottom Line: Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears.No major complications were seen.As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.

ABSTRACT

Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling.

Objectives: Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy.

Patients and methods: One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis.

Results: Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen.

Conclusion: As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

No MeSH data available.


Related in: MedlinePlus

Distal tip of dedicated bronchoscope with the curved array transducer covered with a saline inflated baloon (a) and echogenic needle pushed out of the bronchoscope (b)
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fig529: Distal tip of dedicated bronchoscope with the curved array transducer covered with a saline inflated baloon (a) and echogenic needle pushed out of the bronchoscope (b)

Mentions: The diagnostic value of conventional TBNA in the tissue diagnosis of mediastinal and hilar LNs is between 40% and 50%. Furthermore, this ratio changes between 15% and 85% depending on the size and location of the LN. Thus, the use of this method is decreased particularly in small LNs (9, 10). Mediastinoscopy which is used for lung cancer staging still maintains its importance as a reference technique. The disadvantages of mediastinoscopy which has a quite high sensitivity (90% to 95%) are that it is an invasive method requiring general anesthesia and it cannot reach all mediastinal LNs; therefore, additional staging methods such as thoracoscopy are needed in many cases. Furthermore, the fact that mediastinoscopy has a 2-3% complication rate may be considered as a disadvantage (6, 7, 11). Ultrasound has been increasingly incorporated into diagnostic and therapeutic modalities. Ultrasound technology may be employed via a probe inserted through the working channel (radial probe EBUS) or incorporated into the distal end of the bronchoscope (convex probe EBUS), the latter allowing real-time biopsy. The convex probe EBUS bronchoscope, which incorporates the ultrasound transducer at its distal end, utilizes a fixed array of transducers aligned in a curvilinear pattern. This generates a 50° image parallel to the long axis of the bronchoscope. Use of a 7.5-MHz frequency allows deeper tissue penetration. Using the water-filled balloon can improve the image quality (Figure 1). Power Doppler capability differentiates the tissue from the vascular structure. Ultrasound and the white-light bronchoscopic images can be viewed simultaneously (12).


The role of convex probe endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of malignant mediastinal and hilar lymph nodes.

Caglayan B, Salepci B, Dogusoy I, Fidan A, Sener Comert S, Kiral N, Yavuzer D, Sarac G - Iran J Radiol (2012)

Distal tip of dedicated bronchoscope with the curved array transducer covered with a saline inflated baloon (a) and echogenic needle pushed out of the bronchoscope (b)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569549&req=5

fig529: Distal tip of dedicated bronchoscope with the curved array transducer covered with a saline inflated baloon (a) and echogenic needle pushed out of the bronchoscope (b)
Mentions: The diagnostic value of conventional TBNA in the tissue diagnosis of mediastinal and hilar LNs is between 40% and 50%. Furthermore, this ratio changes between 15% and 85% depending on the size and location of the LN. Thus, the use of this method is decreased particularly in small LNs (9, 10). Mediastinoscopy which is used for lung cancer staging still maintains its importance as a reference technique. The disadvantages of mediastinoscopy which has a quite high sensitivity (90% to 95%) are that it is an invasive method requiring general anesthesia and it cannot reach all mediastinal LNs; therefore, additional staging methods such as thoracoscopy are needed in many cases. Furthermore, the fact that mediastinoscopy has a 2-3% complication rate may be considered as a disadvantage (6, 7, 11). Ultrasound has been increasingly incorporated into diagnostic and therapeutic modalities. Ultrasound technology may be employed via a probe inserted through the working channel (radial probe EBUS) or incorporated into the distal end of the bronchoscope (convex probe EBUS), the latter allowing real-time biopsy. The convex probe EBUS bronchoscope, which incorporates the ultrasound transducer at its distal end, utilizes a fixed array of transducers aligned in a curvilinear pattern. This generates a 50° image parallel to the long axis of the bronchoscope. Use of a 7.5-MHz frequency allows deeper tissue penetration. Using the water-filled balloon can improve the image quality (Figure 1). Power Doppler capability differentiates the tissue from the vascular structure. Ultrasound and the white-light bronchoscopic images can be viewed simultaneously (12).

Bottom Line: Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears.No major complications were seen.As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.

ABSTRACT

Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling.

Objectives: Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy.

Patients and methods: One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis.

Results: Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen.

Conclusion: As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

No MeSH data available.


Related in: MedlinePlus