Limits...
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

A, Right lower paratracheal lymph node. The tip of the needle is shown with an arrow. The echogenic view under the tip of the needle is an internal echo of the lymph node; B, The correlative CT image of the right lower paratracheal lymph node.Abbreviations: LN; lymph node, VCS; vena cava superior
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3569549&req=5

fig530: A, Right lower paratracheal lymph node. The tip of the needle is shown with an arrow. The echogenic view under the tip of the needle is an internal echo of the lymph node; B, The correlative CT image of the right lower paratracheal lymph node.Abbreviations: LN; lymph node, VCS; vena cava superior

Mentions: CP-EBUS-guided TBNA from hilar and mediastinal lymph nodes were performed after physical examination, chest X-ray and thoracic CT. Routine biochemical analysis, pulmonary function tests and PET-CT were done if indicated. EBUS-guided TBNA examinations were performed in all cases at the pulmonary department as an outpatient procedure in a dedicated bronchoscopy suit with a 7.5 MHz, BF-UC160F (Olympus Optical Co., Tokyo, Japan, approved by FDA) convex probe bronchoscope and EU C2000 processor (Olympus, Tokyo, Japan) by oral route and in the supine position under local anesthesia with lidocaine and conscious sedation with intravenous midazolam. Lymph nodes were identified according to the Mountain’s regional lymph node classification system (15). The lymph node stations of 2, 4, 7, 10 and 11 were evaluated systematically. The dimensions of the lymph nodes seen on the CP-EBUS were recorded from frozen ultrasound images. In the presence of any lymph node with a short axis greater than 0.5 cm, even if CT- and PET-CT were negative, EBUS-guided TBNA was performed with real-time imaging (Figure 2). Olympus 22 -gauge NA-201SX-4022-C needle (approved by FDA) was used for the procedure. During the process for every detected lymph node; short and long axis diameters, station of the lymph node, number of passes per patient and per lymph node were recorded for each patient. To avoid contamination in lung cancer patients, N3 nodes were sampled first and then N2 nodes were punctured.


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)

A, Right lower paratracheal lymph node. The tip of the needle is shown with an arrow. The echogenic view under the tip of the needle is an internal echo of the lymph node; B, The correlative CT image of the right lower paratracheal lymph node.Abbreviations: LN; lymph node, VCS; vena cava superior
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig530: A, Right lower paratracheal lymph node. The tip of the needle is shown with an arrow. The echogenic view under the tip of the needle is an internal echo of the lymph node; B, The correlative CT image of the right lower paratracheal lymph node.Abbreviations: LN; lymph node, VCS; vena cava superior
Mentions: CP-EBUS-guided TBNA from hilar and mediastinal lymph nodes were performed after physical examination, chest X-ray and thoracic CT. Routine biochemical analysis, pulmonary function tests and PET-CT were done if indicated. EBUS-guided TBNA examinations were performed in all cases at the pulmonary department as an outpatient procedure in a dedicated bronchoscopy suit with a 7.5 MHz, BF-UC160F (Olympus Optical Co., Tokyo, Japan, approved by FDA) convex probe bronchoscope and EU C2000 processor (Olympus, Tokyo, Japan) by oral route and in the supine position under local anesthesia with lidocaine and conscious sedation with intravenous midazolam. Lymph nodes were identified according to the Mountain’s regional lymph node classification system (15). The lymph node stations of 2, 4, 7, 10 and 11 were evaluated systematically. The dimensions of the lymph nodes seen on the CP-EBUS were recorded from frozen ultrasound images. In the presence of any lymph node with a short axis greater than 0.5 cm, even if CT- and PET-CT were negative, EBUS-guided TBNA was performed with real-time imaging (Figure 2). Olympus 22 -gauge NA-201SX-4022-C needle (approved by FDA) was used for the procedure. During the process for every detected lymph node; short and long axis diameters, station of the lymph node, number of passes per patient and per lymph node were recorded for each patient. To avoid contamination in lung cancer patients, N3 nodes were sampled first and then N2 nodes were punctured.

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