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- Endobronchial Ultrasound Bronchoscope Insertion Through a Flexible Tracheostomy Tube: A Novel Approach to Perform EBUS in Patients With Closed Upper Airway. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):799A.
Bronchology/Interventional Procedures Student/Resident CasesSESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 07:30 AM - 08:30 AMINTRODUCTION: Endobronchial ultrasound (EBUS) with fine needle aspiration biopsy is now the standard of care in lung cancer diagnosis and staging. The procedure is routinely performed under conscious sedation in a bronchoscopy suite. A convex-probe EBUS (CP-EBUS) scope has limited flexion and extension when compared to a regular bronchoscope. The scope is routinely inserted orally using a bite block. Laryngeal mask airway or endotracheal tube is required when the procedure is performed under general anesthesia. We here in report insertion of CP-EBUS through a tracheostomy tube without mechanical damage to the scope. Using this approach trans-bronchial fine needle aspiration biopsy of enlarged mediastinal lymph nodes can be safely performed in patients with closed upper airway by passing the CP- EBUS through a flexible tracheostomy tube.A 73-year-old woman presented to the emergency department with respiratory distress, throat pain and difficulty swallowing for four months. CT neck revealed a partially blocking laryngeal mass. Otolaryngology was consulted and she was emergently taken to the operating room for a tracheostomy. Biopsy of the supraglottic laryngeal mass, confirmed squamous cell carcinoma. Positron emission tomography scan performed for staging revealed enlarged mediastinal and hilar lymph nodes with increased Standardized Uptake Value. Pulmonary service was consulted for a trans-bronchial fine needle aspiration biopsy of the mediastinal and hilar lymph nodes. In order to safely insert the CP-EBUS bronchoscope into the airway, the fixed bend tracheostomy tube was changed to a flexible tracheostomy tube by otolaryngology. The procedure was successfully performed without mechanical damage to the scope.CP-EBUS is a specialized bronchoscope that allows for identification and real time needle aspiration biopsy of lymph nodes and mediastinal structures located adjacent to the airway wall. Patients with cancer require careful preoperative staging to determine resectability and to initiate appropriate management. The sensitivity and specificity are high when performed by an experienced pulmonologist. It is mechanically difficult to insert the CP-EBUS scope through a tracheostomy tube as the ultrasound cannot pass through the bend of the tube. We describe a case of successfully inserting the CP-EBUS scope through a silicone flexible tracheostomy tube without any mechanical damage to the scope. Caution should be taken when changing a newly performed tracheostomy.CONCLUSIONS: It is now possible to perform fine needle aspiration biopsy of enlarged mediastinal and hilar lymph nodes using CP-EBUS in patients with tracheostomy with upper airway obstruction. Reference #1: Nakajima T, Yasufuku K, Yoshino I. Current status and perspective of EBUS-TBNA. General thoracic and cardiovascular surgery. 2013 Jul;61(7):390-6. PubMed PMID: 23436118DISCLOSURE: The following authors have nothing to disclose: Bilal Jalil, Fuzail Ahmad Abdur Rahman, Ali SaeedNo Product/Research Disclosure Information.
- Transbronchial Biopsies in Lung Cancer: Retrospective Review of 116 Patients. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):795A.
Bronchoscopy Posters IISESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Bronchoscopy with transbronchial biopsy (TBB) is an interesting tool in the investigation of lung cancer. We aimed to describe the yield and safety of TBB in the evaluation of pulmonary malignancy.We retrospectively reviewed the data of 116 TBB performed to assess lung lesions executed between January 2013 and December 2013 at a tertiary center. We evaluated these procedures in terms of diagnostic yield for neoplasia and complications.The mean age of the patients was 66 years old (range 26-88), with 55 males (48.9%). The mean number of biopsies was 4.28 (±1.46). The diagnostic yield from TBB alone for lung cancer was 37.9% (44/116), while when combined with other sampling procedures (such as bronchial biopsy, bronchoalveolar lavage or brush), diagnostic yield was 43.1% (50/116). When linear endobronchial ultrasound (EBUS) was performed during the same procedure, diagnostic yield further increased to 58.6% (68/116). A higher number of biopsies improved the diagnostic yield (72.7% with > 5 biopsies vs 36.7% with 3-5 biopsies vs 0% with 1-2 biopsies; p= 0.015). Diagnostic yield was higher when lesions measured ≥ 30 mm (46.3%; 31/67) compared with nodules <30 mm in diameter (25.6%; 10/39) [p=0.041]. Adjuncts such as radial EBUS (8/116), electromagnetic navigation (19/116), fluoroscopy (17/116) and cryoprobe (4/116) were used in 29 TBB (25%), with no significant effect on diagnostic yield (p=0.659). Location of lung lesion and tissue sample size did not significantly impact the diagnostic yield. The main complication was bleeding (≥ 30 cc or at least moderate as estimated by the bronchoscopist), which was seen in 7 cases (6%). Tranexamic acid and bronchoscopic balloon were required in 2 cases of bleeding. Only one patient suffered from a small pneumothorax (0.9 %) that did not necessitate chest drainage. Specimen size, number of biopsies and adjuncts did not increase the risk of complications.Efficacy of TBB for the diagnosis of lung cancer is optimized when performed with linear EBUS, > 5 biopsies and lesions ≥ 30 mm. TBB appears to be a relatively safe procedure, with no significant rise in risk of complications with higher number of biopsies.In the assessment of pulmonary malignancy, TBB is more useful with larger lesions. Adding linear EBUS and performing > 5 biopsies significantly enhance the diagnostic yield of TBB for lung cancer.DISCLOSURE: The following authors have nothing to disclose: Ping Shi Zhu, Charles D. Poirier, Michel Gagnon, Thomas VandemoorteleNo Product/Research Disclosure Information.
- The Initial Examination of Endobronchial Ultrasound-Guided Bronchial Ethanol Injection Therapy (EBUS-BEIT) for Endobronchial Tumors. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):771A.
Bronchology/Interventional Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Bronchial ethanol injection therapy is a palliative therapy for air way stenosis caused by lung cancer. It is effective for endobronchial polypoid tumors but ineffective for extrawall tumors. There were no indication of effects resulting from ethanol injection or air way leakage of ethanol. We performed an initial study to examine the ability of endobronchial ultrasound-guided bronchial ethanol injection therapy (EBUS-BEIT) to reduce the blood flow and volume of an endobronchial tumor causing tracheal stenosis; percutaneous ethanol injection therapy (PEIT) was also performed for a liver cell tumor and a parathyroid tumor.CASE PRESENTATION: A 56-year-old man was admitted to our hospital for treatment of tracheal stenosis due to recurring squamous cell carcinoma. We performed EBUS-BEIT prior to stent placement. While viewing the tumor in real time using EBUS, we injected 0.2 ml ethanol into the tumor. High echoic lesions appeared near the tip of the needle after injection of ethanol, and we were able to confirm lesions of coagulative necrosis. There were three patterns of high echoic lesion expanse in the tumor; however, we could not detect these patterns prior to ethanol injection. We repeated EBUS-BEIT until high echoic lesions were apparent in the entire tumor, and we confirmed blood flow reduction by Doppler echocardiography. There were few bleeding events that occurred when we performed tumor debulking followed by DUMON stent placement.DISCUSSION: Because EBUS avoids normal mediastinum structures, we expect this therapy to be effective for extrawall tumors．The limitation of this therapy was that the region depicted using EBUS is very difficult to view by bronchoscopy.CONCLUSIONS: We could confirm ethanol expanse in the tumor using EBUS-BEIT and blood flow reduction using Doppler echocardiography in real time. After EBUS-BEIT, there were few bleeding events that occurred during tumor debulking, and thus we could confirm the actual blood flow reduction effect using ethanol.Reference #1: Fujisawa T, Hongo H, Tamaguchi Y, et al. Intratumoral ethanol injection for malignant tracheobronchial lesions: A new bronchofiberscopic procedure. Endoscopy 1986;18:188-191 Chan AL, Yoneda KY, Allen RP, et al. Advances in the management of endobronchial lung malignancies. Curr Opin Pilm Med 2003;9:301-308Reference #2: Chan AL, Yoneda KY, Allen RP, et al. Advances in the managemant of endobronchial lung malignancies. Curr Opin Pilm Med 2003;9:301-308DISCLOSURE: The following authors have nothing to disclose: Shinichi Iwamoto, Hibiki Kanda, Mitsuhiro Tada, Emiko Nishikawa, Toru Kadowaki, Masahiro Kimura, Kanako Kobayashi, Toshikazu Ikeda, Shuichi YanoNo Product/Research Disclosure Information.
- Direct Comparison of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and Cervical Mediastinoscopy for the Diagnosis of Suspected Sarcoidosis. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):753A.
EBUS InsightsSESSION TYPE: Original Investigation SlidePRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PMPURPOSE: Sarcoidosis remains a challenging diagnostic dilemma. Cervical mediastinoscopy (CMED) with lymph node sampling remains a gold standard for evaluation of suspected sarcoidosis. Endobronchial ultrasound with transbronchial needle biopsy (EBUS-TBNA) has shown promise for diagnosis in the setting of mediastinal adenopathy. Prior studies have shown EBUS-TBNA to have high yield in diagnosis of sarcoidosis, yet direct comparisons of EBUS-TBNA to mediastinoscopy have never been performed. Our aim was to compare EBUS-TBNA to mediastinoscopy for suspected sarcoidosis.METHODS: We performed a retrospective chart review of all patients undergoing combined CMED and EBUS-TBNA as part of their usual care between November 2007 to December 2011 at Boston Medical Center. Only subjects undergoing evaluation for suspected sarcoidosis were included in the analysis. All subjects had lymph nodes sent for pathology and culture (bacterial, fungal, mycobacterial). A diagnosis of sarcoidosis was made if non-caseating granulomas were detected, cultures were finalized as negative, and no alternative diagnosis was made on follow up.Of 61 subjects who underwent combined EBUS-TBNA and CMED, 19 subjects were ultimately diagnosed with early stage (stage I or II) sarcoidosis. EBUS-TBNA sampled a mean of 1.84 lymph node stations (range 1-3), while CMED sampled a mean of 1.79 lymph node stations (range 1-3). Granulomas were detected by CMED in all patients. EBUS-TBNA detected non-caseating granulomas in 17 of the 19 sarcoid subjects (sensitivity 89.5%). For five subjects in which only one lymph node station was sampled by EBUS-TBNA sensitivity was 60%, while the sensitivity for the remaining 14 subjects with more then one lymph node station sampled was 100%. The two subjects where granulomas were not detected by EBUS-TBNA had only one station sampled (both R-XI).CONCLUSIONS: EBUS-TBNA may be used as an alternative to CMED for the diagnosis of sarcoidosis, providing at least two stations are sampled. Negative EBUS-TBNA may necessitate CMED.CLINICAL IMPLICATIONS: EBUS-TBNA may be used as an alternative to CMED as long as two or more lymph node stations are sampled.DISCLOSURE: The following authors have nothing to disclose: Yaron Gesthalter, Jeffrey Berman, Hiran Fernando, Michael EbrightNo Product/Research Disclosure Information.
- Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Complete Nodal Staging of Lung Cancer in Patients With N0 Disease by CT and Integrated PET/CT. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):751A.
EBUS InsightsSESSION TYPE: Original Investigation SlidePRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PMPURPOSE: The role of EBUS-TBNA for staging of lung cancer in patients with radiographically N0 disease is still unclear. The available data is scant, from a single institution, and it does not involve the use of "integrated" PET-CT.METHODS: Retrospective review of EBUS-TBNA performed for lung cancer staging at Michael Debakey VA Medical Center from 08/2009 to 03/2014. Patients with radiographic N0 disease (lymph nodes ≤1cm in the short axis and SUV max ≤2.5 by PET/CT) were included. Primary outcome was sensitivity and negative predictive value of EBUS-TBNA. The gold standard was surgical pathology or 6 months radiological follow-up.RESULTS: Ninety seven patients were identified. Primary tumors were: adenocarcinoma =46, squamous cell=39, others=12. These tumors were centrally located in 22% and median tumor size was 3 cm (range, 1-10 cm). A total of 406 LN were sampled by EBUS-TBNA (4.2 ± 1.4 per patient), mean diameter was 8mm. Of 97 patients, 45 (46%) underwent surgery, 30 (31%) stereotactic radiation, and 22 (23%) chemo-radiation. Twenty two patients (22.7%) were ultimately upstaged from radiographic staging. Ten (10.3%) identified by EBUS (N1=6, N2=3, N3=1), an additional 11 patients (11.3%) identified at surgical resection (N1 intralobar= 6, N1 extralobar= 1, and N2=4 [two stations 7, two stations 5- 6]), and 1 upstaged during follow-up. False negative rate of EBUS-TBNA was 4.1% when excluding patients with occult disease "outside" the reach of EBUS. EBUS-TBNA sensitivity to detect lymph node metastases was 45.5% (95%CI 25.1 - 67.3) and NPV was 86.2% (95%CI 76.8 to 92.4).This is the first report of EBUS-TBNA in patients with N0 disease by "integrated" PET-CT. Both sensitivity and NPV of EBUS-TBNA were lower than previously reported in patients with normal mediastinum by CT or PET.CLINICAL IMPLICATIONS: EBUS-TBNA may still play a role in the nodal staging of patients with lung cancer and clinical N0 disease, particularly in patients who will not undergo nodal dissection. Prospective studies are needed to evaluate the role of EBUS in these patients.DISCLOSURE: The following authors have nothing to disclose: Philip Ong, George Eapen, Donald Lazarus, Venkata Bandi, Sarah Perusich, Luis Tamara, Lorraine Cornwell, Angela Zhu, Roberto CasalNo Product/Research Disclosure Information.
- Improving Quantity and Quality for Histological Differentiation and Molecular Analysis in Transbronchial Needle Aspirations. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):750A.
EBUS InsightsSESSION TYPE: Original Investigation SlidePRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PMPURPOSE: Personalized genomic medicine has become a center of focus for lung cancer treatment. Key biomarkers of main interest that directly impact first line therapy in adenocarcinoma are Epidermal growth factor receptor (EGFR) and the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocation. As the demand for more tissue is on the rise to perform these tests, so is the demand for less invasive testing modalities, especially endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We instituted a TBNA standardized specimen acquisition protocol to improve yield for histological subtyping of NSCLC and molecular analysis for EGFR and ALK testing.METHODS: During the procedure, two slides are made for each TBNA aspirate. One slide is stained for rapid on-site cytology (ROSE) and the other is placed in ethanol. Remaining material in the needle is rinsed into CytoLyt® Solution. Once ROSE confirms the presence of malignant cells, three dedicated passes are made and the full contents of the aspirate is rinsed into the CytoLyt® Solution. If NSCLC is suspected, a final pass is made and two unstained slides are reserved for ALK testing. If the final pathology read is "adenocarcinoma" or "NSCLC, favor adenocarcinoma" ALK gene rearrangement testing and EGFR mutation testing is performed. We compared prospectively collected data after instituting the protocol to yields before standardization.We reviewed 219 cases sampling 315 nodes. Overall sensitivity was 94% and specificity 100%. Fifty-four cases (n=119) were malignancy, 71 of which were NSCLC. Sixty-four occurred before the new protocol and seven after. There were 19 cases of squamous cell and 40 cases of adenocarcinoma. Not otherwise specified and poorly differentiated reduced from 6% to 0% with the new protocol. Sufficient material for ALK and EGFR testing occurred in 46% of adenocarcinoma pre-protocol and 90% of adenocarcinoma post-protocol.CONCLUSIONS: With the implementation of a standardized sampling protocol with TBNA, we have so far reduced our incidences of NOS and increased quality pathologic material available for molecular analysis. This was a newly instituted protocol and we anticipate generating additional statistically significant data over the next six months.A standardized protocol for specimen acquisition during TBNA may maximize tissue for diagnosis, histological subtyping, and molecular analysis.DISCLOSURE: The following authors have nothing to disclose: Christina Bellinger, Deepankar Sharma, Travis DotsonNo Product/Research Disclosure Information.
- Ultrathin Bronchoscopy With Multimodal Devices for Peripheral Pulmonary Lesions: A Randomized Study. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):745A.
Bronchoscopy and Interventional ProceduresSESSION TYPE: Original Investigation SlidePRESENTED ON: Monday, October 27, 2014 at 01:30 PM - 02:30 PMPURPOSE: Endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) have been reported to enhance the diagnostic accuracy of bronchoscopy for peripheral pulmonary lesions. The combination of thinner bronchoscopes and navigational technology seems to make the best of mutual abilities, but ultrathin bronchoscopes which allow the use of EBUS have not been developed so far. The purpose of the present study was to compare the diagnostic yields of transbronchial biopsy (TBB) under EBUS, fluoroscopy and VBN guidance using a novel ultrathin bronchoscope and a thin bronchoscope with a guide sheath (GS) for peripheral pulmonary lesions.METHODS: In four centers, a total of 310 patients with suspected peripheral lesions ≤ 30 mm in the longest diameter on CT were included and randomized to undergo TBB with EBUS, fluoroscopy and VBN guidance using a 3.0-mm ultrathin bronchoscope (UTB group) or a 4.0-mm thin bronchoscope with a guide sheath (TB-GS group). Except for the bronchoscopes and a guide sheath, the same type devices or instruments such as a 1.4-mm radial ultrasonic probe and biopsy forceps were used in both groups.RESULTS: A total of 310 patients were enrolled and randomized, among whom 305 patients (150, UTB group; 155, TB-GS group) were included in the analysis. Median lesion size in the longest diameter was 18.8 mm in UTB group and 19.4 mm in TB-GS group. Diagnostic histologic specimens were obtained in 73% (37% for benign and 82% for malignant lesions) of UTB group and 60% (33% for benign and 73% for malignant lesions) of TB-GS group (p = 0.01). Complications including pneumothorax, bleeding, chest pain and pneumonia occurred in 3% and 5% in the respective groups.CONCLUSIONS: The diagnostic yield of the UTB method is higher than that of the TB-GS method.CLINICAL IMPLICATIONS: Ultrathin bronchoscopy under EBUS, fluoroscopy and VBN guidance provides a high diagnostic yield for small peripheral pulmonary lesions.DISCLOSURE: The following authors have nothing to disclose: Masahide Oki, Hideo Saka, Masahiko Ando, Noriaki Kurimoto, Katsuhiko Morita, Fumihiro Asano, Chiyoe Kitagawa, Yoshihito Kogure, Teruomi MiyazawaWe used prototype ultrathin bronchoscopes, which were loaned to the authors by Olympus, Tokyo, Japan.
- Molecular Analysis of EBUS-TBNA vs Conventional TBNA in the Diagnosis of Non-small Cell Lung Cancer. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):744A.
EBUS and Advanced Bronchoscopy PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Lung cancer diagnosis and staging requires sufficient material for identifying the type of cancer, the subtype of cancer, and pertinent molecular markers. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to achieve all of these goals but few head-to-head comparisons exists for EBUS-TBNA versus conventional TBNA (cTBNA). Many lymph nodes are potentially amenable to either cTBNA or EBUS-TBNA sampling but little published data exists directly comparing yield, sample adequacy, and nodule characteristics at a single institution.METHODS: 219 total TBNAs (145 EBUS & 74 cTBNA) were retrospectively reviewed to compare size of target lymph nodes, sensitivity and specificity, sample adequacy, NSCLC differentiation, and yield for determination of ALK and EGFR, when appropriate.RESULTS: Composite sensitivity was 94% and specificity 100%. EBUS-TBNA targeted smaller nodules 16±8mm vs 25±15mm (p<0.001), as at our institution larger nodes and masses are usually sampled via cTBNA and EBUS-TBNA is performed on smaller nodes and for staging. Overall yield was comparable (91% vs 94%, p value>0.05) for both sampling modalities as was not otherwise specified (NOS) material. NSCLC was differentiated in a comparable manner using both modalities and there was no statistically significant difference in sufficiency of material for driver mutation analysis of echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) (54% vs 60%) or Epidermal growth factor receptor (EGFR) (54% vs 45%).CONCLUSIONS: EBUS-TBNA and cTBNA are complimentary procedures with a similar diagnostic yield and similar yield for specimen adequacy of driver mutations.CLINICAL IMPLICATIONS: When large lesions are sampled and full mediastinal staging is not needed, cTBNA can provide similarly sufficient material for cytology and molecular analysis compared to EBUS-TBNA.DISCLOSURE: The following authors have nothing to disclose: Jonathan Hovda, Travis Dotson, Christina BellingerNo Product/Research Disclosure Information.
- NIR Spectroscopy Based Navigational Device for Real-Time Solitary Pulmonary Nodule Biopsy. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):743A.
EBUS and Advanced Bronchoscopy PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: New endobronchial navigational device has been tested. We compared confirmatory value of near infrared (NIR) spectroscopy navigational catheter with endobronchial ultrasound in diagnostic algorithm of SPN. Fluoroscopic guidance was executed in all patients. TBB with histology and needle biopsy with cytology evaluation were also done in all patients.METHODS: In our study we used 2 point monitoring confirmatory systems. Fluoroscopic guidance has been combined with either radial EBUS probe or NIR spectroscopy probe tissue confirmation. NIR spectroscopic probe has been designed containing flexible forceps to achieve real- time biopsy during navigation procedure. Instrument functionality is based on measurement of penetrated NIR radiation through lung tissue. Both indicating and source fibres in one bundle are navigated towards the SPN Patient population consisted of 210 patients with CT/PET finding of metabolically active solitary pulmonary node 1.2-3 cm in diameter examined from 11/2011 to 4/2013. There were 139 male and 71 female patients with medial age 68 years. 82% of them were smokers with homogenous distribution in both groups. EBUS radial probe was used as described elsewhere during fluoroscopy navigation.From 106 patients in the fluoroscopy + EBUS group there were 82 histologies/cytologies confirming the diagnosis with the hit rate of the procedure in our cohort 77%. NIR spectroscopy + fluoroscopy use led to hit rate 87% with 90 of positive histologies/cytologies in 104 patients.NIR spectroscopy catheter navigation with real - time biopsy technique has got insignificantly better efficacy as radial EBUS in confirmation of ideal biopsy place in our group of patients. The amount of positive biopsies were however more dependent on the ability of bronchologist to direct confirmatory device to SPN during fluoroscopy guidance than on the type of confirmatory device. The advantage of NIR- navigation is in real- time biopsy possibility and much lower cost of the technique.Recently SPNs are more often encountered because of the widespread use of CT for the diagnostic and screening purposes. We introduce new navigational technic with good comparative value against EBUS navigation. Such device could be easily included for example into the examination by electromagnetic navigation.DISCLOSURE: The following authors have nothing to disclose: Jiri Votruba, Tomas BruhaTechnique has been approved by local ethic commitee and is completely non-invasive.
- The Use of Convex-Probe Endobronchial Ultrasound Guided Biopsy in the Diagnosis of Parenchymal Pulmonary Nodules via Segmental Bronchi. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):742A.
EBUS and Advanced Bronchoscopy PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: The most common modalities used to diagnose parenchymal lung nodules include bronchoscopic biopsy guided by fluoroscopy, electromagnetic navigation or radial probe endobronchial ultrasound, and also CT-guided needle biopsy and surgical biopsy. The convex-probe endobronchial ultrasound bronchoscope (EBUS) is a well established tool to guide needle aspiration of central thoracic structures that abut the airways, primarily mediastinal and hilar lymph nodes, but also central parenchymal lesions. We report a series of 9 patients in which EBUS was used to accurately locate and guide transbronchial needle aspiration (TBNA) of more peripheral parenchymal pulmonary nodules (PPN) via segmental lower lobe bronchi (SB).Patients who underwent EBUS-TBNA of mediastinal or hilar nodes and also had attempted EBUS guided biopsy of PPN via SB with a convex probe EBUS scope (Olympus BF-UC160F-OL8) were identified by review of procedure logs. Cytology and pathology results, location of PPN, and complications were reviewed. Specimens were designated as adequate if a specific diagnosis was obtained with the EBUS specimen.Since September 2013, 9 patients received 9 procedures with the intention of obtaining a TBNA of mediastinal or hilar nodes, and visualization of the PPN was attempted during the procedure. 8 PPN in the mid to outer third of the lower lobes were visualized and sampled through SB. One PPN in the outer third of the lung deep in the costophrenic sulcus could not be visualized with EBUS. The patients also underwent standard TBNA of mediastinal lymph nodes. EBUS-TBNA of PPN was adequate in 7/8 procedures, and was suspicious for carcinoma in one additional procedure. In total 5 patients were diagnosed with a malignancy (4 non-small cell lung cancer, 1 metastatic colon cancer) and 2 patients had a benign diagnosis (1 sarcoidosis, 1 MAI). In 4 procedures, EBUS-TBNA of PPN provided the only diagnostic samples. There were no complications attributable to the procedure.In our experience, EBUS-TBNA of PPN via SB is a high yield and safe sampling method when the PPN can be visualized. Due to the size and limited flexibility of this bronchoscope, this technique is limited to lower lobe nodules in the mid to outer third of the lung.EBUS-TBNA appears to be a useful and safe modality for patients with peripheral pulmonary lesions that may complement the current modalities available, especially in patients who need sampling of intrathoracic lymph nodes.The following authors have nothing to disclose: Isaac Shalom, Timothy HarkinNo Product/Research Disclosure Information.