Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes

doi:10.1378/chest.126.1.122

Chest

Volume 126, Issue 1, July 2004, Pages 122-128

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Study objectives:

Although various techniques are available for obtaining pathology specimens from the mediastinal lymph nodes, including conventional bronchoscopic transbronchial needle aspiration (TBNA), transesophageal ultrasonography-guided needle aspiration, and mediastinoscopy, there are limitations to these techniques, which include low yield, poor access, need for general anesthesia, or complications. To overcome these problems, we undertook the current study to evaluate the clinical utility of the newly developed ultrasound puncture bronchoscope to visualize and perform real-time TBNA of the mediastinal and hilar lymph nodes under direct endobronchial ultrasonography (EBUS) guidance.

Design:

Prospective patient enrollment.

Setting:

University teaching hospital.

Patients:

From March 2002 to September 2003, 70 patients were included in the study.

Interventions:

The new convex probe (CP) EBUS is integrated with a convex scanning probe on its tip with a separate working channel, thus permitting real-time EBUS-guided TBNA. The indications for CP-EBUS were the diagnosis of mediastinal and/or hilar lymphadenopathy for known or suspected malignancy. Lymph nodes and the surrounding vessels were first visualized with CP-EBUS using the Doppler mode. The dimensions of the lymph nodes were recorded, followed by real-time TBNA under direct EBUS guidance. Final diagnosis was based on cytology, surgical results, and/or clinical follow-up.

Results:

All lymph nodes that were detected on the chest CT scan could be visualized using CP-EBUS. In 70 patients, CP-EBUS-guided TBNA was performed to obtain samples from mediastinal lymph nodes (58 nodes) and hilar lymph nodes (12 nodes). The sensitivity, specificity, and accuracy of CP-EBUS-guided TBNA in distinguishing benign from malignant lymph nodes were 95.7%, 100%, and 97.1%, respectively. The procedure was uneventful, and there were no complications.

Conclusions:

Real-time CP-EBUS-guided TBNA of mediastinal and hilar lymph nodes is a novel approach that is safe and has a good diagnostic yield. This new ultrasound puncture bronchoscope has an excellent potential for assisting in safe and accurate diagnostic interventional bronchoscopy.

Section snippets

Patients

Between March 2002 and September 2003, 70 patients having mediastinal and/or hilar lymphadenopathy of > 1 cm and with known or suspected malignancy were included in the study. A chest radiograph and CT scan of the chest (plain and contrast- enhanced) were performed in all patients.

Written informed consent was obtained from all the patients included in the study. Conventional flexible bronchoscopy (model BF-240 bronchoscope; Olympus; Tokyo, Japan) was first performed in a standard fashion to

Results

Seventy patients underwent CP-EBUS (52 men and 18 women; mean age, 64.3 years; SD, 10.4 years; range, 37 to 86 years). All lymph nodes that were detected on the chest CT scan could be visualized using CP-EBUS. Direct real-time CP-EBUS-guided TBNA was performed in all 70 patients to obtain samples from mediastinal lymph nodes (58 nodes) and hilar lymph nodes (12 nodes). The procedure was uneventful, and there were no complications.

Figures 2 and 3show the CT scan appearance of the lymph nodes,

Discussion

Present investigation methods in radiology such as CT and US have resulted in a decrease in the number of mediastinoscopies performed.¹¹ The limitations, complications, or morbidity associated with thoracoscopy,¹² CT scan-guided percutaneous needle aspiration of mediastinal lymph nodes,⁵ and conventional TBNA² have led some institutions to use transesophageal fine-needle aspiration to sample mediastinal lymph nodes. The need for direct EBUS-guided TBNA has been expressed previously.^6,^7,¹³ The

ACKNOWLEDGMENT

The authors thank Kenichi Nishina and Yusuke Ichikawa (Olympus Optical Corporation) for technical assistance.

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Clinical InvestigationsLUNG CANCERReal-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes

Study objectives:

Design:

Setting:

Patients:

Interventions:

Results:

Conclusions:

Section snippets

Patients

Results

Discussion

ACKNOWLEDGMENT

Chest

J Thorac Cardiovasc Surg

Chest

Chest

Chest

Chest

Chest

Chest

J Thorac Cardiovasc Surg

Clinical Investigations
LUNG CANCER
Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes