Endobronchial Ultrasound With Transbronchial Needle Aspiration (EBUS-TBNA) in Patients With Negative Results in Conventional Bronchoscopy

Introduction

Transbronchial needle aspiration (TBNA) is a well-established procedure during bronchoscopy that has been in use for about the last 20 years. Using TBNA, tissue sampling is feasible from paratracheal and parabronchial lymph nodes and tumors in the lung parenchyma adjacent to the trachea and bronchi. The diagnostic yield of the procedure depends on the distance from bronchial epithelial surface to the tumor, location, and size of the target lesion and experience of the performing physician. However, even though TBNA is known to be effective in the mediastinal staging of lung cancer especially regarding lower subcarinal and hilar lymph nodes, the technique is not consistently used by pneumologists.TBNA has been employed more frequently in recent years. However, this procedure that offers no direct visual guidance cannot be reasonably employed in a lymph nodes smaller than 1.5 cm in size.

Abstract

PURPOSE

The aim of this retrospective study is to evaluate the role of endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) in patients with enlarged lymph nodes or masses suspicious of malignancy and negative results on conventional bronchoscopy.

PATIENTS AND METHODS

From December 2008 to September 2010, 208 patients with enlarged lymph nodes or lesions suspicious of malignancy were examined by EBUS. Every patient underwent a CT-scan or PET-CT and conventional bronchoscopy with comprehensive tissue sampling. Only patients with normal tissue as a result of the examination and lesions that were not at reach for EUS were eligible for EBUS-TBNA.

RESULTS

In 96.6%, EBUS-TBNA was technically feasible. In 3.4%, target lesions were too small or beyond reach of the TBNA-system. Sensitivity reached 74% in procedures performed for staging of lung cancer. Futile surgery could be avoided in eight cases with positive samples from lymph nodes in the N2 or N3 position. In assumed lung cancer stage IIIB and IV, sensitivity was 81%. In cases with suspected tumors others than lung cancer, 80% sensitivity was achieved. In evaluation of recurrent disease, we obtained a sensitivity of 90%. EBUS-TBNA yielded 62% sensitivity in cases with suspected lung cancer stage I/II and 58% in assumed sarcoidosis. Sarcoidosis was the result of every sixth EBUS-TBNA carried out in patients with enlarged lymph node of unclear significance. The rate of complications was low (pneumothorax in one case, .49%).

CONCLUSION

We experience EBUS-TBNA as a valuable tool to add diagnostic accuracy and safety in a considerable number of patients in our daily clinical practice. The procedure is characterized by a low rate of complications. We were able to avoid surgical diagnostic procedures in a substantial number of cases.

Keywords

endobronchial ultrasound, bronchoscopy, TBNa, diagnosis