Skip to main content

Advertisement

SpringerLink
Log in

Is endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) reliable and safe procedure in geriatric patients?

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

A Correction to this article was published on 22 April 2022

This article has been updated

Abstract

Background

Even though studies have indicated the usefulness and safety of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA), elderly patient data are limited due to the small sample sizes.

Aim

We aimed to evaluate usage and safety of EBUS-TBNA in elderly population.

Methods

This single-center retrospective study was conducted with patients who underwent an EBUS-TBNA procedure between September 2011 and December 2019. The patients were categorized into two groups: those aged 65 years or older (elderly group) and those younger than 65 years (younger group).

Results

2444 patient data, 1069 of which were in the elderly group, were analyzed. The cytological examination of EBUS-TBNA identified specimen adequacy in 96.8% of patients. One hundred and thirty patients (5.3%) experienced complications, with similar complication rates recorded in both the elderly and younger groups (5.4% vs 5.2%, p: 0.836). Logistic regression analyses revealed that age, and presence of hypertension, diabetes mellitus, coronary artery disease and malignancy are associated significantly with complication-related EBUS-TBNA. For the lymph nodes with a final diagnosis of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EBUS-TBNA revealed a diagnostic performance in excess of 90% except for metastasis and lymphoma.

Conclusion

EBUS-TBNA can be considered a safe and effective technique in patients aged 65 years and over.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Change history

References

  1. Vilmann P, Clementsen PF, Colella S et al (2015) Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy 47:545. https://doi.org/10.1055/s-0034-1392453

    Article  PubMed  Google Scholar 

  2. Silvestri GA, Gonzalez AV, Jantz MA et al (2013) Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e211S-e250S. https://doi.org/10.1378/chest.12-2355

    Article  PubMed  Google Scholar 

  3. Dziedzic D, Peryt A, Szolkowska M et al (2016) Evaluation of the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration for metastatic mediastinal tumors. Endosc Ultrasound 5:173–177. https://doi.org/10.4103/2303-9027.183973

    Article  PubMed  PubMed Central  Google Scholar 

  4. Labarca G, Folch E, Jantz M et al (2018) Adequacy of samples obtained by endobronchial ultrasound with transbronchial needle aspiration for molecular analysis in patients with non-small cell lung cancer. Systematic review and meta-analysis. Ann Am Thorac Soc 15:1205–1216. https://doi.org/10.1513/AnnalsATS.201801-045OC

    Article  PubMed  Google Scholar 

  5. Pilleron S, Sarfati D, Janssen-Heijnen M et al (2019) Global cancer incidence in older adults, 2012 and 2035: a population-based study. Int J Cancer 144:49–58. https://doi.org/10.1002/ijc.31664

    Article  CAS  PubMed  Google Scholar 

  6. DeSantis CE, Miller KD, Dale W et al (2019) Cancer statistics for adults aged 85 years and older. CA Cancer J Clin 69:452–467. https://doi.org/10.3322/caac.21577

    Article  PubMed  Google Scholar 

  7. Marosi C, Koller M (2016) Challenge of cancer in the elderly. ESMO Open 1:e000020. https://doi.org/10.1136/esmoopen-2015-000020

    Article  PubMed  PubMed Central  Google Scholar 

  8. Estape T (2018) Cancer in the elderly: challenges and barriers. Asia Pac J Oncol Nurs 5:40–42. https://doi.org/10.4103/apjon.apjon_52_17

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rusch VW, Asamura H, Watanabe H et al (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 4:568–577. https://doi.org/10.1097/JTO.0b013e3181a0d82e

    Article  PubMed  Google Scholar 

  10. Muthu V, Sehgal IS, Dhooria S et al (2019) Endobronchial ultrasound-guided transbronchial needle aspiration: techniques and challenges. J Cytol 36:65–70. https://doi.org/10.4103/JOC.JOC_171_18

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hu LX, Chen RX, Huang H et al (2016) Endobronchial ultrasound-guided transbronchial needle aspiration versus standard bronchoscopic modalities for diagnosis of sarcoidosis: a meta-analysis. Chin Med J (Engl) 129:1607–1615. https://doi.org/10.4103/0366-6999.184458

    Article  Google Scholar 

  12. Du Rand IA, Blaikley J, Booton R et al (2013) British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 68:i1–i44. https://doi.org/10.1136/thoraxjnl-2013-203618

    Article  PubMed  Google Scholar 

  13. Dhooria S, Sehgal IS, Gupta N et al (2020) Diagnostic utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the elderly. J Bronchol Interv Pulmonol 27:22–29. https://doi.org/10.1097/LBR.0000000000000605

    Article  Google Scholar 

  14. Haga T, Cho K, Nakagawa A et al (2016) Complications of fiberoptic bronchoscopy in very elderly adults. J Am Geriatr Soc 64:676–677. https://doi.org/10.1111/jgs.13999

    Article  PubMed  Google Scholar 

  15. Rokach A, Fridlender ZG, Arish N et al (2008) Bronchoscopy in octogenarians. Age Ageing 37:710–713. https://doi.org/10.1093/ageing/afn127

    Article  PubMed  Google Scholar 

  16. Hehn BT, Haponik E, Rubin HR et al (2003) The relationship between age and process of care and patient tolerance of bronchoscopy. J Am Geriatr Soc 51:917–922. https://doi.org/10.1046/j.1365-2389.2003.51303.x

    Article  PubMed  Google Scholar 

  17. Figueiredo VR, Jacomelli M, Rodrigues AJ et al (2013) Current status and clinical applicability of endobronchial ultrasound-guided transbronchial needle aspiration. J Bras Pneumol 39:226–237. https://doi.org/10.1590/S1806-37132013000200015

    Article  PubMed  PubMed Central  Google Scholar 

  18. Noda N, Hara M, Ise S et al (2020) Comfort and safety of bronchoscopy performed under sedation and local anesthesia in elderly patients. Medicine (Baltimore) 99:e22561. https://doi.org/10.1097/MD.0000000000022561

    Article  Google Scholar 

  19. Scarlata S, Costa F, Pascarella G et al (2020) Remifentanil target-controlled infusion for conscious sedation in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): a case series. Clin Drug Investig 40:985–988. https://doi.org/10.1007/s40261-020-00960-0

    Article  PubMed  Google Scholar 

  20. Bailey N, Krisnadi Z, Kaur R et al (2019) A pragmatic application of endobronchial ultrasound-guided transbronchial needle aspiration: a single institution experience. BMC Pulm Med 19:155. https://doi.org/10.1186/s12890-019-0909-4

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fournier C, Hermant C, Gounant V et al (2019) Diagnostic of mediastinal lymphadenopathy in extrathoracic cancer: a place for EBUS-TBNA in real life practice? Respir Med Res-Franc 75:1–4. https://doi.org/10.1016/j.resmer.2019.03.001

    Article  CAS  Google Scholar 

  22. Dziedzic D, Peryt A, Szolkowska M et al (2016) Evaluation of the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration for metastatic mediastinal tumors. Endoscopic Ultrasound 5:173–177. https://doi.org/10.4103/2303-9027.183973

    Article  PubMed  PubMed Central  Google Scholar 

  23. Demirdogen E, Ursavas A, Aydin Guclu O et al (2020) Diagnostic performance of EBUS-TBNA and its interrelation with PET-CT in patients with extra-thoracic malignancies. Tuberk Toraks 68:285–292. https://doi.org/10.5578/tt.70045

    Article  PubMed  Google Scholar 

  24. Erer OF, Erol S, Anar C et al (2017) Diagnostic yield of EBUS-TBNA for lymphoma and review of the literature. Endoscopic Ultrasound 6:317–322. https://doi.org/10.4103/2303-9027.180762

    Article  PubMed  PubMed Central  Google Scholar 

  25. Grosu HB, Iliesiu M, Caraway NP et al (2015) Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis and subtyping of lymphoma. Ann Am Thorac Soc 12:1336–1344. https://doi.org/10.1513/AnnalsATS.201503-165OC

    Article  PubMed  Google Scholar 

  26. Krimsky W, Muganlinskaya N, Sarkar S et al (2016) The changing anatomic position of squamous cell carcinoma of the lung—a new conundrum. J Community Hosp Intern Med Perspect 6:33299. https://doi.org/10.3402/jchimp.v6.33299

    Article  PubMed  Google Scholar 

  27. Janssen-Heijnen ML, Maas HA, Siesling S et al (2012) Treatment and survival of patients with small-cell lung cancer: small steps forward, but not for patients >80. Ann Oncol 23:954–960. https://doi.org/10.1093/annonc/mdr303

    Article  CAS  PubMed  Google Scholar 

  28. Carter BW, Glisson BS, Truong MT et al (2014) Small cell lung carcinoma: staging, imaging, and treatment considerations. Radiographics 34:1707–1721. https://doi.org/10.1148/rg.346140178

    Article  PubMed  Google Scholar 

  29. Thieblemont C, Bernard S, Molina T (2017) Management of aggressive lymphoma in very elderly patients. Hematol Oncol 35:49–53. https://doi.org/10.1002/hon.2413

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mohammed TLH, Chowdhry A, Reddy GP et al (2011) ACR appropriateness criteria (R) screening for pulmonary metastases. J Thorac Imag 26:W1–W3. https://doi.org/10.1097/RTI.0b013e3182010bf9

    Article  Google Scholar 

  31. Nin CS, de Souza VV, do Amaral RH et al (2016) Thoracic lymphadenopathy in benign diseases: a state of the art review. Respir Med 112:10–17. https://doi.org/10.1016/j.rmed.2016.01.021

    Article  PubMed  Google Scholar 

  32. Erol S, Anar C, Erer OF et al (2018) Does anthracosis reported in endobronchial ultrasound-guided transbronchial needle aspiration exclude metastasis? Eurasian J Pulmonol 20:12–16

    Article  Google Scholar 

  33. Arkema EV, Cozier YC (2018) Epidemiology of sarcoidosis: current findings and future directions. Ther Adv Chronic Dis 9:227–240. https://doi.org/10.1177/2040622318790197

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jamilloux Y, Bonnefoy M, Valeyre D et al (2013) Elderly-onset sarcoidosis: prevalence, clinical course, and treatment. Drugs Aging 30:969–978. https://doi.org/10.1007/s40266-013-0125-5

    Article  CAS  PubMed  Google Scholar 

  35. Saji J, Kurimoto N, Morita K et al (2011) Comparison of 21-gauge and 22-gauge needles for endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. J Bronchol Interv Pulmonol 18:239–246. https://doi.org/10.1097/LBR.0b013e3182273b41

    Article  Google Scholar 

  36. Colella S, Scarlata S, Bonifazi M et al (2018) Biopsy needles for mediastinal lymph node sampling by endosonography: current knowledge and future perspectives. J Thorac Dis 10:6960–6968. https://doi.org/10.21037/jtd.2018.11.35

    Article  PubMed  PubMed Central  Google Scholar 

  37. Elmufdi FS, Peterson MK, Niccum D et al (2021) Evaluating yield of 19 versus 21 G EBUS-TBNA needles: a prospective study. J Bronchol Interv Pulmonol 28:29–33. https://doi.org/10.1097/LBR.0000000000000674

    Article  Google Scholar 

  38. Wahidi MM, Herth F, Yasufuku K et al (2016) Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report. Chest 149:816–835. https://doi.org/10.1378/chest.15-1216

    Article  PubMed  Google Scholar 

  39. Leong TL, Christie M, Kranz S et al (2017) Evaluating the genomic yield of a single endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: meeting the challenge of doing more with less. Clin Lung Cancer 18:e467–e472. https://doi.org/10.1016/j.cllc.2017.05.006

    Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Chest Diseases, Faculty of Medicine, Ankara University, 06620, Ankara, Turkey

    Aslıhan Gürün Kaya, Aydın Çiledağ, Serhat Erol, Miraç Öz, Deniz Doğan Mülazımoğlu, Özlem Işık, Fatma Çiftçi, Elif Şen, Demet Karnak, Gökhan Çelik, Akın Kaya & İsmail Savaş

  2. Department of Pathology, Faculty of Medicine, Ankara University, Ankara, Turkey

    Koray Ceyhan

Authors
  1. Aslıhan Gürün Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aydın Çiledağ
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Serhat Erol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miraç Öz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deniz Doğan Mülazımoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Özlem Işık
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fatma Çiftçi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elif Şen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koray Ceyhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Demet Karnak
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gökhan Çelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Akın Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. İsmail Savaş
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception, design and material preparation. Data collection and analysis were performed by AGK, ÖI, DDM, and MÖ. The first draft of the manuscript was written by AGK, and all the authors reviewed and edited the previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Aslıhan Gürün Kaya.

Ethics declarations

Conflict of interest

All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

Ethical approval was waived by the local Ethics Committee of Ankara University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care (Ethics approval number: İ2-176-21).

Statement of human and animal rights

We declare that all procedures performed in studies involving human participants were in accordance with the ethical standards of the Human Research Ethics Committee of Ankara University (Ethical approval number: İ2-176-21) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Not applicable (retrospective nature of the study and all the procedures being performed were part of the routine care).

Consent for publication

Not applicable (retrospective nature of the study and all the procedures being performed were part of the routine care).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gürün Kaya, A., Çiledağ, A., Erol, S. et al. Is endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) reliable and safe procedure in geriatric patients?. Aging Clin Exp Res 34, 913–925 (2022). https://doi.org/10.1007/s40520-021-02012-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-021-02012-9

Keywords

Search

Navigation