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The role of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal processes other than lung cancer

  • Mediastinal Diseases (D. Hsia, Section Editor)
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Abstract

The role of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration has expanded to include diseases other than lung cancer. In isolated mediastinal adenopathy with a low likelihood of lung cancer, EBUS has sensitivity of 92 %, and can prevent unnecessary mediastinoscopies. The procedure has an established use in sarcoidosis (overall diagnostic yield of 79 %) and in TB lymphadenitis with negative routine cultures. While the evidence in support of EBUS in lymphoma is not as robust, the technique may be used as a minimally invasive first-line diagnostic test. Novel roles for EBUS, such as the diagnosis of pulmonary thromboembolism, have also been described.

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References

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  1. Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e142S–65.

    Article  PubMed  Google Scholar 

  2. Ernst A et al. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. J Thorac Oncol. 2008;3(6):577–82.

    Article  PubMed  Google Scholar 

  3. Yasufuku K et al. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg. 2011;142(6):1393–400 e1.

    Article  PubMed  Google Scholar 

  4. Garwood S et al. Endobronchial ultrasound for the diagnosis of pulmonary sarcoidosis. Chest. 2007;132(4):1298–304.

    Article  PubMed  Google Scholar 

  5. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999. 160(2): p. 736-55.

  6. Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest. 1995;107(2):430–2.

    Article  CAS  PubMed  Google Scholar 

  7. Villaneuve, M. and P. Kvale. Textbook of Bronchoscopy. (Lipincott Williams and Wilkins, 1995), 64.

  8. Zavala DC. Complications following fiberoptic bronchoscopy. The "good news" and the "bad news". Chest. 1978;73(6):783–5.

    Article  CAS  PubMed  Google Scholar 

  9. Wong M et al. Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis. Eur Respir J. 2007;29(6):1182–6.

    Article  CAS  PubMed  Google Scholar 

  10. Oki M et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology. 2007;12(6):863–8.

    Article  PubMed  Google Scholar 

  11. Nakajima T et al. The role of EBUS-TBNA for the diagnosis of sarcoidosis–comparisons with other bronchoscopic diagnostic modalities. Respir Med. 2009;103(12):1796–800.

    Article  PubMed  Google Scholar 

  12. Navani N et al. Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis. Respirology. 2011;16(3):467–72.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Plit M et al. Diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration compared with transbronchial and endobronchial biopsy for suspected sarcoidosis. Intern Med J. 2012;42(4):434–8.

    Article  CAS  PubMed  Google Scholar 

  14. Oki M et al. Prospective study of endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes versus transbronchial lung biopsy of lung tissue for diagnosis of sarcoidosis. J Thorac Cardiovasc Surg. 2012;143(6):1324–9.

    Article  PubMed  Google Scholar 

  15. von Bartheld MB et al. Endosonography vs conventional bronchoscopy for the diagnosis of sarcoidosis: the GRANULOMA randomized clinical trial. JAMA. 2013;309(23):2457–64. This is the largest prospective multicenter randomized trial to show that endosongraphy TBNA is superior to conventional brochoscopic biopsy in evaluating suspected sarcoidosis, with far fewer complications.

    Article  Google Scholar 

  16. Tremblay A et al. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest. 2009;136(2):340–6.

    Article  PubMed  Google Scholar 

  17. Gupta, D., et al. Endobronchial Ultrasound Guided TBNA vs. Conventional TBNA in the diagnosis of sarcoidosis. Chest. 2014.

  18. Herth F, Becker HD, Ernst A. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial. Chest. 2004;125(1):322–5.

    Article  PubMed  Google Scholar 

  19. Wallace MB et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA. 2008;299(5):540–6.

    Article  CAS  PubMed  Google Scholar 

  20. Trisolini R, Lazzari Agli L, Patelli M. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration of the mediastinum. Chest. 2004;126(3):1005–6.

    Article  PubMed  Google Scholar 

  21. Eckardt J et al. Minimally invasive diagnosis of sarcoidosis by EBUS when conventional diagnostics fail. Sarcoidosis Vasc Diffuse Lung Dis. 2010;27(1):43–8.

    CAS  PubMed  Google Scholar 

  22. Tournoy KG et al. The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis. Eur Respir J. 2010;35(6):1329–35.

    Article  CAS  PubMed  Google Scholar 

  23. Agarwal R et al. Efficacy and safety of convex probe EBUS-TBNA in sarcoidosis: a systematic review and meta-analysis. Respir Med. 2012;106(6):883–92.

    Article  PubMed  Google Scholar 

  24. Plit ML et al. Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis. Eur Respir J. 2013;42(5):1302–8. This study demonstrated that rapid on-site pathological review can be helpful in sarcoidosis to determine when an initial diagnosis has been made, or to direct the bronchosocpist when more tissue is needed before ending a procedure. It has the potential to limit unnecessary procedures.

    Article  PubMed  Google Scholar 

  25. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128(4):2893–909.

    Article  PubMed  Google Scholar 

  26. WHO Classification of Tumours of Heamatopoietic and Lymphoid Tissue, (International Agency for Research on Cancer, 2008).

  27. Ko HM et al. Diagnosis and subclassification of lymphomas and non-neoplastic lesions involving mediastinal lymph nodes using endobronchial ultrasound-guided transbronchial needle aspiration. Diagn Cytopathol. 2013;41(12):1023–30.

    Article  PubMed  Google Scholar 

  28. Demurtas A et al. Utility of flow cytometry immunophenotyping in fine-needle aspirate cytologic diagnosis of non-Hodgkin lymphoma: A series of 252 cases and review of the literature. Appl Immunohistochem Mol Morphol. 2010;18(4):311–22.

    Article  PubMed  Google Scholar 

  29. Hehn ST, Grogan TM, Miller TP. Utility of fine-needle aspiration as a diagnostic technique in lymphoma. J Clin Oncol. 2004;22(15):3046–52.

    Article  PubMed  Google Scholar 

  30. Porte H et al. The role of mediastinoscopy in the diagnosis of mediastinal lymphadenopathy. Eur J Cardiothorac Surg. 1998;13(2):196–9.

    Article  CAS  PubMed  Google Scholar 

  31. Kennedy MP et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma. Thorax. 2008;63(4):360–5.

    Article  CAS  PubMed  Google Scholar 

  32. Steinfort DP et al. Endobronchial ultrasound-guided transbronchial needle aspiration for the evaluation of suspected lymphoma. J Thorac Oncol. 2010;5(6):804–9.

    Article  PubMed  Google Scholar 

  33. Marshall CB et al. The utility of endobronchial ultrasound-guided transbronchial needle aspiration biopsy in the diagnosis of mediastinal lymphoproliferative disorders. Cancer Cytopathol. 2011;119(2):118–26.

    Article  PubMed  Google Scholar 

  34. Iqbal S et al. Endobronchial ultrasound and lymphoproliferative disorders: a retrospective study. Ann Thorac Surg. 2012;94(6):1830–4.

    Article  PubMed  Google Scholar 

  35. Moonim MT et al. Diagnosis and subtyping of de novo and relapsed mediastinal lymphomas by endobronchial ultrasound needle aspiration. Am J Respir Crit Care Med. 2013;188(10):1216–23. This study prospectively demonstrated the utility of EBUS in diagnosing de novo lymphoma as well as recurrent disease, with a majority of the samples satisfactory for clinical management. EBUS diagnosed several alternative etiologies in suspected recurrent disease.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Herth FJ et al. Endobronchial ultrasound-guided miniforceps biopsy in the biopsy of subcarinal masses in patients with low likelihood of non-small cell lung cancer. Ann Thorac Surg. 2008;85(6):1874–8.

    Article  PubMed  Google Scholar 

  37. Chrissian A, Misselhorn D, Chen A. Endobronchial-ultrasound guided miniforceps biopsy of mediastinal and hilar lesions. Ann Thorac Surg. 2011;92(1):284–8.

    Article  PubMed  Google Scholar 

  38. Navani N et al. Endobronchial ultrasound-guided transbronchial needle aspiration prevents mediastinoscopies in the diagnosis of isolated mediastinal lymphadenopathy: a prospective trial. Am J Respir Crit Care Med. 2012;186(3):255–60. This study demonstrated that EBUS can be effectively used as a first-line minimally invasive diagnostic modality in unspecified isolated mediastinal adenopathy, with substantial cost savings to the health care system. However, the negative predictive value of EBUS was low , especially compared with how it performs in lung cancer.

    Article  PubMed Central  PubMed  Google Scholar 

  39. WHO. World Health Organization (WHO). Global tuberculosis report 2013. Available from: http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf.

  40. Peto HM et al. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis. 2009;49(9):1350–7.

    Article  PubMed  Google Scholar 

  41. Codecasa LR et al. Epidemiological and clinical patterns of intrathoracic lymph node tuberculosis in 60 human immunodeficiency virus-negative adult patients. Monaldi Arch Chest Dis. 1998;53(3):277–80.

    CAS  PubMed  Google Scholar 

  42. Navani N et al. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study. Thorax. 2011;66(10):889–93.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Ren S et al. Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques enhanced the diagnosis yields of pulmonary tuberculosis patients with lymphadenopathy. Panminerva Med. 2013;55(4):363–70.

    CAS  PubMed  Google Scholar 

  44. Sun J et al. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis. Ann Thorac Surg. 2013;96(6):2021–7.

    Article  PubMed  Google Scholar 

  45. Pastis Jr NJ et al. Mediastinal lymphadenopathy in patients undergoing cardiac transplant evaluation. Chest. 2011;139(6):1451–7.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Erly WK et al. Location, size, and distribution of mediastinal lymph node enlargement in chronic congestive heart failure. J Comput Assist Tomogr. 2003;27(4):485–9.

    Article  PubMed  Google Scholar 

  47. Tian Q, Chen LA, Hu H. Infectious risk enhanced because of endobronchial ultrasound-guided transbronchial needle aspiration of bronchogenic cysts. J Bronchol Interv Pulmonol. 2010;17(3):283–4.

    Article  Google Scholar 

  48. Twehues A, Islam S. Cystic lesions of the thorax: role of endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchol Interv Pulmonol. 2011;18(3):265–8.

    Article  Google Scholar 

  49. Anantham D et al. Role of endobronchial ultrasound in the diagnosis of bronchogenic cysts. Diagn Ther Endosc. 2011;2011:468237.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Aumiller J et al. Endobronchial ultrasound for detecting central pulmonary emboli: a pilot study. Respiration. 2009;77(3):298–302.

    Article  CAS  PubMed  Google Scholar 

  51. Casoni GL et al. Diagnosis of pulmonary thromboembolism with endobronchial ultrasound. Eur Respir J. 2008;32(5):1416–7.

    Article  CAS  PubMed  Google Scholar 

  52. Harris K, Chalhoub M. Endobronchial ultrasound as a confirmatory tool for the diagnosis of pulmonary embolism. Ann Thorac Med. 2014;9(2):127–8.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Sachdeva A et al. Endobronchial ultrasound diagnosis of pulmonary embolism. J Bronchol Interv Pulmonol. 2013;20(1):33–4.

    Article  Google Scholar 

  54. Senturk A et al. Diagnostic imaging of pulmonary embolism using endobronchial ultrasound. Arch Bronconeumol. 2013;49(6):268–71.

    Article  PubMed  Google Scholar 

  55. Swartz MA, Gillespie CT. Pulmonary emboli detected by endobronchial ultrasound. Am J Respir Crit Care Med. 2011;183(11):1569.

    Article  PubMed  Google Scholar 

  56. Egea Santaolalla CJ, Ribas Solis FJ, Juste Carne M. Pulmonary thromboembolism observed by endobronchial ultrasound (EBUS). Arch Bronconeumol. 2011;47(3):164–5.

    Article  CAS  PubMed  Google Scholar 

  57. Sanz-Santos J et al. Diagnosis of acute pulmonary embolism by endobronchial ultrasound as an incidental finding. Respiration. 2011;81(2):150–1.

    Article  CAS  PubMed  Google Scholar 

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Brian Furukawa and Nicholas J. Pastis each declare that there are no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 812, MSC 630, Charleston, SC, 29425-6300, USA

    Brian Furukawa & Nicholas J. Pastis

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Correspondence to Nicholas J. Pastis.

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Furukawa, B., Pastis, N.J. The role of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal processes other than lung cancer. Curr Respir Care Rep 3, 179–186 (2014). https://doi.org/10.1007/s13665-014-0086-0

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