EBUS-TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy
Introduction
Lung cancer is the leading cause of cancer death with a 5-year survival rate of only 16% [1]. Lung cancer may be suspected in patients presenting with either an abnormal chest radiograph or with symptoms resulting from local or systemic tumour effects. If lung cancer is suspected, a histological diagnosis, in conjunction with accurate staging, should be obtained whenever possible in order to guide therapy and prognosis [2], [3].
Flexible fibreoptic or video-bronchoscopy with its associated procedures (endobronchial biopsy, brushing and washing) is valuable in patients with suspected lung cancer, especially if there is endobronchial tumour visible. However, many central tumours are not visible at bronchoscopy due to their submucosal or parabronchial position and in these situations diagnostic yield by standard bronchoscopic techniques is much lower [4], [5], [6]. The addition of transbronchial needle aspiration (TBNA) may increase diagnostic rates [7] but this technique is not widely practiced and the yield is heavily operator-dependent. Although CT-guided transthoracic needle aspirations for centrally located parabronchial lesions can be undertaken, there is a high risk of pneumothorax and hemoptysis [8]. In addition, the diagnostic yield is lower than for peripheral lesions [8].
Convex curvi-linear endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) is a useful technique for mediastinal lymph node staging of non-small cell lung cancer [9], [10], [11], [12]. In this paper, we have evaluated the yield and the clinical impact of using EBUS-TBNA for diagnosing centrally located parenchymal lung lesions which are not visible by conventional bronchoscopy and which are hardly amenable to CT-guided needle biopsy.
Section snippets
Study design and patients
We retrospectively reviewed the diagnostic performance of EBUS-TBNA in patients with a high clinical suspicion of a centrally located primary lung cancer. These patients were referred to three expert institutions to obtain a tissue diagnosis of the primary lung lesion by EBUS-TBNA. The centrally located lung lesions were defined as an intrapulmonary mass with the medial margin located within the inner third of the hemithorax based on chest CT-scan imaging. Patients with primary mediastinal
Results
In this international retrospective series, 60 patients (36 male) were referred between April 2006 and October 2007 to Ghent University Hospital, Belgium (n = 25), Papworth Hospital, Cambridge, UK (n = 10) or Leiden University Medical Center, The Netherlands (n = 25) for EBUS-TBNA to obtain a tissue diagnosis of lung lesion suspected to be malignant and with its medial margin within one-third of the hemithorax (Fig. 1).
Table 1 details patient characteristics. Forty-nine (82%) patients had a previous
Discussion
In this study, EBUS-TBNA provided a diagnosis of malignancy in 77% of patients with a centrally sited lung lesion that was not visible at routine bronchoscopy. The sensitivity to diagnose lung cancer was 82%. In addition, in this setting EBUS-TBNA was shown to be both safe and have a high impact on patient management.
Flexible bronchoscopy and CT/ultrasound guided transthoracic needle aspiration are the most commonly used techniques to obtain a tissue diagnosis when lung cancer is suspected.
Conflict of interest
None declared.
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