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Pulmonology Procedures |

Diagnostic Yield of EBUS TBNA for the Evaluation of Centrally Located Peribronchial Pulmonary Lesions

Hammad Bhatti*, MD; Abubakr Bajwa, MD; James Cury, MD; Adil Shujaat, MD; Lisa Jones, MD; Faisal Usman, MD
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University of Florida College of Medicine, Jacksonville, FL


Chest. 2012;142(4_MeetingAbstracts):871A. doi:10.1378/chest.1382256
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Abstract

SESSION TYPE: Endobronchial Ultrasound

PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM

PURPOSE: To evaluate the diagnostic yield of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) as a single step method for centrally located lung masses when used solely or in conjunction with either endobronchial forceps biopsy (EBBx) or 2D -fluoroscopic guided transbronchial forceps biopsy (TBLBx).

METHODS: This was a single center retrospective analysis of consecutive patients who had been detected with centrally located peribronchial lesions (medial margin of the mass within inner third of hemithorax on CT imaging). Patients who underwent EBUS-TBNA from 2008 to 2011 were included. EBUS-TBNA was either used as a sole method or simultaneously with either endobronchial forceps biopsy or 2D Fluoroscopy-guided TBLBx for lung masses suspected of malignancy

RESULTS: A total of 32 cases were studied. Mean age was 69.1 years. Half of them were males. EBUS-TBNA detected malignancy in 30 patients (93.8 %). CT-guided biopsy confirmed diagnosis in the two remaining cases. Out of 32 patients, 21 patients had EBUS-TBNA performed simultaneously with either 2D-fluoroscopic guided TBLBx(n=13) or EBBx (n=8). In 13 patients who had 2D-fluoroscopic guided TBLBx ,it was positive in 8/13 cases (61.3%) while EBUS-TBNA was positive in 12/13 cases (95%). In 8 patients with endobronchial lesions, EBBx was positive in 6/8 cases (75%) while EBUS-TBNA was positive in all cases 8/8 (100%). Total cases that would have been missed if EBUS-TBNA was not used concomitantly with TBLBx or EBBx were 6/21 (28%). Additionally, there were 10 patients where EBUS-TBNA was used as a sole method for sampling, due to either lack of an endobronchial target or inability to perform TBLBx due to central nature of the lesion and all of them were positive for malignancy. Two patients had moderate amount of bleeding requiring localized diluted epinephrine.

CONCLUSIONS: EBUS-TBNA showed excellent diagnostic yield in centrally located lung masses.

CLINICAL IMPLICATIONS: In a centrally located lung mass deemed accessible, EBUS-TBNA,should be considered as an important adjunct to other techniques to enhance the diagnostic yield.

DISCLOSURE: The following authors have nothing to disclose: Hammad Bhatti, Abubakr Bajwa, James Cury, Adil Shujaat, Lisa Jones, Faisal Usman

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University of Florida College of Medicine, Jacksonville, FL

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