SESSION TITLE: EBUS: New Approaches
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM
PURPOSE: To describe the feasibility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for diagnosis of thyroid lesions.
METHODS: After IRB approval, we reviewed all EBUS cases performed at the Michael E. DeBakey VA Medical Center in Houston, TX, from February 2010 to June 2012. We then selected those in which a thyroid biopsy was performed with EBUS-TBNA, retrieving and analyzing demographic and clinical data.
RESULTS: We identified 10 cases of EBUS-TBNA thyroid biopsy. All but one patient were referred to us with an indication for EBUS other than their thyroid lesions. Thyroid lesions were sampled during the same procedure in which lymph nodes or paratracheal masses were sampled. The median age was 64 years (range 55 to 84 years), and 9 patients were male. Median lesion size was 22.5 mm (range, 10 to 33mm). Nine lesions were on the left and one on the right. Four lesions were strictly intrathoracic. Nine patients underwent EBUS-TBNA under general anesthesia via a laryngeal mask airway (LMA); the remaining patient was done under moderate sedation. All cases were sampled with a 22G needle and rapid on-site examination (ROSE). Adequate samples were obtained in all 10 cases. Malignancy was identified in 3 of the 10 patients (metastatic breast adenocarcinoma, large B-cell lymphoma, and metastatic adenocarcinoma from the lung). The remaining 7 samples were benign nodules and confirmed by clinical follow-up (n=3), biopsies (n=3), or surgery (n=1). None of the patients experienced EBUS-related complications.
CONCLUSIONS: EBUS-TBNA might be a safe and effective alternative for sampling thyroid lesions. Further prospective studies are required to compare its diagnostic yield and safety profile with the standard techniques.
CLINICAL IMPLICATIONS: This small case series illustrates a potentially high diagnostic yield and favorable safety profile of EBUS-TBNA for the sampling of thyroid lesions. The risk of pneumothorax or major vessel injury from standard CT-guided or ultrasound-guided FNA of intrathoracic thyroid lesions could be prevented.
DISCLOSURE: The following authors have nothing to disclose: Mimi Phan, Donald Lazarus, Juan Iribarren, Roberto Casal
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