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British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults
  1. I A Du Rand1,
  2. P V Barber2,
  3. J Goldring3,
  4. R A Lewis4,
  5. S Mandal5,
  6. M Munavvar6,
  7. R C Rintoul7,
  8. P L Shah8,
  9. S Singh9,
  10. M G Slade7,
  11. A Woolley4,
  12. on behalf of the British Thoracic Society Interventional Bronchoscopy Guideline Group
  1. 1Queen Elizabeth Hospital, Birmingham, UK
  2. 2North West Lung Centre, University Hospital of South Manchester, Manchester, UK
  3. 3Royal Free Hospital, London, UK
  4. 4Worcestershire Royal Hospital, Worcester, UK
  5. 5Lane-Fox Unit, St Thomas' Hospital, London, UK
  6. 6Lancashire Teaching Hospitals NHS Trust, Preston, UK
  7. 7Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
  8. 8Department of Respiratory Medicine at Royal Brompton Hospital, London, Chelsea & Westminster Hospital, and Imperial College, London, UK
  9. 9Chelsea and Westminster Hospital, London, UK
  1. Correspondence to Dr Ingrid A Du Rand, The British Thoracic Society, 17 Doughty Street, London WC1N 2PL, UK; ingrid.durand{at}nhs.net

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Summary of recommendations

Diagnosis of mediastinal/hilar lymph nodes and peribronchial masses
Conventional transbronchial fine needle aspiration (TBNA)
B
  • Conventional transbronchial needle aspiration (TBNA) is a safe technique and should be used to sample mediastinal and hilar lymphadenopathy during initial diagnostic bronchoscopy where a pre-procedure CT scan has demonstrated significant adenopathy.

  • Conventional TBNA is a safe technique for sampling hilar and mediastinal lymph nodes in cases of suspected sarcoidosis and may be used in conjunction with endobronchial and transbronchial biopsies.

  • Depending upon the clinical setting, a non-diagnostic conventional TBNA result may warrant further investigation. Real-time endobronchial ultrasound-guided TBNA (EBUS-TBNA) or surgical lymph node sampling should be considered.

Endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA)
B
  • EBUS-TBNA is a safe and effective technique for the assessment of hilar and mediastinal lymph nodes in cases of confirmed or suspected lung cancer.

  • EBUS-TBNA is a safe and effective technique for sampling hilar and mediastinal lymph nodes in cases of suspected sarcoidosis and may be used in conjunction with endobronchial and transbronchial biopsies.

D
  • EBUS-TBNA is a safe and effective technique for sampling paratracheal and peribronchial intraparenchymal lung masses.

  • At present there is insufficient evidence to recommend EBUS-TBNA for routine use in the diagnosis of lymphoma.

  • In cases where EBUS-TBNA results are negative for malignancy, a confirmatory surgical biopsy should be performed where appropriate.

Therapeutic procedures for malignant disease
Malignant airway obstruction
1. Endobronchial debulking of tumours
D
  • In patients with central airway obstruction (CAO) due to intraluminal tumour, endobronchial tumour debulking should be considered.

  • When undertaking endobronchial debulking of tumours, a laryngeal mask or uncuffed endotracheal tube is recommended to achieve airway control.

2. Endobronchial electrocautery or diathermy
D
  • Endobronchial electrocautery may be considered for use with curative intent in benign disease of the airway including incising web-like stenosis, benign tumours and granulation tissue. It may also be considered for primary treatment of early stage non-invasive lung cancer.

  • Endobronchial electrocautery may be considered for palliation of malignant CAO, with or without critical airway narrowing.

  • When undertaking snare resection, intermittent bursts of electrocautery of not more than 2 s duration should be used …

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Footnotes

  • Membership of the Committee with their conflicts of interest are shown in Appendix 1 and a list of stakeholders is given in Appendix 5.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internal and external peer review undertaken by the Standards of Care Committee of the British Thoracic Society.