PURPOSE: The purpose of the current study was to evaluate the usefulness of endobronchial ultrasound in the diagnosis of pulmonary diseases and staging of malignant pulmonary diseases.
METHODS: one hundred seventy three patients with a possible diagnosis of thoracic malignancies with or without intrathoracic and /or hilar adenopathy or patients with central or peripheral,localized or infilterative lung lesions underwent Endobronchial Ultrasound between December 2007 to December 2009 . Patients were divided into two groups, group A included 147 patients underwent linear probe EBUS with EBUS guided TBNA and group B 26 patients underwent radial probe EBUS.
RESULTS: A total of 173 patients were included in the study. In group A, There were 244 mediastinal & hilar lymph nodes (stations: 2R-3,4R-76, 4L-23, 7-67, 10R-24, 10L-5, 11R-28, 11L-18) and 13 lung mass lesions biopsied. EBUS-TBNA revealed metastatic lymph node involvement in 63 of 147 patients (42.9%) and in 64 of 244 biopsies (26.2%). In 84 patients with negative or uncertain EBUS-TBNA who underwent subsequent surgery, mediastinoscopy, metastatic nodes were diagnosed in four patients (4.8%) in stations: (4R-2,4L-1 & 7-1).The false-negative results of biopsies were found only in small nodes <1cm. There was no significant relation between lymph node size and EBUS-TBNA cytology results (p=0.008), but significant relation between lymph node sonographic characteristics and EBUS-TBNA biopsy result was found (p<0.003).N1/N2 &N3 disease was found in 14, 13&7 patients. In group B, EBUS-TBNA confirmed 18 (69.2%) malignant cases and eight (30.8%) benign cases. RP-EBUS with a guide sheath and fluoroscopy was used for diagnosing 5 peripheral lung lesions with diagnostic yield of 100%.The overall diagnostic yield of CP EBUS- (guided)TBNA and RP-EBUS was 92% and 100% respectively.The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of EBUS-TBNA in group A & group B were (94%, 100%, 100%, 94.7%,and 97.4% and 85.7%,100%,100%,72.7%, and 89.7%) respectively. Mediastinoscopy was avoided in 86 patients. No complications occurred from EBUS-TBNA.
CONCLUSIONS: Endobronchial ultrasound & EBUS-TBNA is an accurate, safe and effective procedure for diagnosing &staging of lung cancers,& benign pulmonary lesions , sparing patients additional, more invasive procedures or surgery.
CLINICAL IMPLICATIONS: EBUS-TBNA sparing patients hazard of more invasive technique & affect managment of lung cancer patients.
DISCLOSURE: The following authors have nothing to disclose: Hamdy Mahmoud
No Product/Research Disclosure Information