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. 2016 Dec;95(50):e5619.
doi: 10.1097/MD.0000000000005619.

Diagnostic performance of convex probe EBUS-TBNA in patients with mediastinal and coexistent endobronchial or peripheral lesions

Akash Verma  1 , Kee San Goh, Chee Kiang Phua, Wen Yuan Sim, Kuan Sen Tee, Albert Y H Lim, Dessmon Y H Tai, Soon Keng Goh, Ai Ching Kor, Benjamin Ho, Sennen J W Lew, John Abisheganaden
Affiliations

Diagnostic performance of convex probe EBUS-TBNA in patients with mediastinal and coexistent endobronchial or peripheral lesions

Akash Verma et al. Medicine (Baltimore). 2016 Dec.

Abstract

To compare the performance of convex probe endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) with conventional endobronchial biopsy (EBB) or transbronchial lung biopsy (TBLB) in patients with mediastinal, and coexisting endobronchial or peripheral lesions.Retrospective review of records of patients undergoing diagnostic EBUS-TBNA and conventional bronchoscopy in 2014.A total of 74 patients had mediastinal, and coexisting endobronchial or peripheral lesions. The detection rate of EBUS-TBNA for mediastinal lesion >1 cm in short axis, EBB for visible exophytic type of endobronchial lesion, and TBLB for peripheral lesion with bronchus sign were 71%, 75%, and 86%, respectively. In contrast, the detection rate of EBUS-TBNA for mediastinal lesion ≤1 cm in short axis, EBB for mucosal hyperemia type of endobronchial lesion, and TBLB for peripheral lesion without bronchus sign were 25%, 63%, and 38%, and improved to 63%, 88%, and 62% respectively by adding EBB or TBLB to EBUS-TBNA, and EBUS-TBNA to EBB or TBLB. Postprocedure bleeding was significantly more common in patients undergoing EBB and TBLB 8 (40%) versus convex probe EBUS-TBNA 2 patients (2.7%, P = 0.0004).EBUS-TBNA is a safer single diagnostic technique compared with EBB or TBLB in patients with mediastinal lesion of >1 cm in size, and coexisting exophytic type of endobronchial lesion, or peripheral lesion with bronchus sign. However, it requires combining with EBB or TBLB and vice versa to optimize yield when mediastinal lesion is ≤1 cm in size, and coexisting endobronchial and peripheral lesions lack exophytic nature, and bronchus sign, respectively.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Representative case of mediastinal and coexisting peripheral parenchymal lesion in the same patient (scale bar in centimeters).
Figure 2
Figure 2
Representative case of visible endobronchial lesion amenable to EBB, peripheral lesion amenable to TBLB, and mediastinal lesion amenable to EBUS-TBNA. (A-1) Patient with exophytic endobronchial lesion in the right bronchus intermedius. (A-2) Patient with mucosal hyperemia type of endobronchial lesion in the right middle lobe. (B-1) Patient with a peripheral parenchymal lesion in the right upper lobe, showing bronchus of posterior segment of the right upper lobe leading into the mass (bronchus sign). (B-2) Patient with a peripheral parenchymal lesion in the right lower lobe without the bronchus sign. (C-1) Patient with a right para-tracheal lymph node of greater than 1 cm in diameter. (C-2) Patient with a right para-tracheal lymph node of lesser than 1 cm in diameter (scale bar in centimeters). EBB = endobronchial biopsy, EBUS-TBNA = endobronchial ultrasound guided transbronchial needle aspiration, TBLB = transbronchial lung biopsy.
Figure 3
Figure 3
Analysis of diagnosis detection rate based on the bronchoscopic technique in the whole group.
Figure 4
Figure 4
Proposed algorithm for the decision making based on the type of lesions in patients with mediastinal, and coexisting endobronchial or peripheral lesions.
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