SESSION TITLE: EBUS: New Insights
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 27, 2013 at 04:15 PM - 05:15 PM
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) allows accurate minimally invasive mediastinal lymph node staging of lung cancer. Due to the size of the current EBUS scope, there are limitations in the access to the N1 nodes especially in the hilar and peripheral zone. The aim of this study was to assess the new thin convex probe endobronchial ultrasound (CP-EBUS) and an aspiration needle for sampling of N1 nodes in a pig model.
METHODS: The prototype thin CP-EBUS (BF-Y0046, OLYMPUS MEDICALSYSTEMS CORP., Tokyo, Japan) with a thinner tip (5.9 mm) and larger bending angle (170 degrees upward) compared to the current CP-EBUS (6.9 mm tip and 120 degrees upward) was used. Accessibility, operability, and TBNA capability of the thin CP-EBUS was assessed in comparison with the conventional CP-EBUS using in-vivo pig lungs. The maximum reach and the point of loss of endoscopic images were evaluated by fluoroscopy at the tracheobronchus, right lower bronchus, and left upper bronchus. TBNA capability was assessed using the prototype aspiration needle (XBO2-138-2, OLYMPUS MEDICALSYSTEMS CORP., Tokyo, Japan) in lobar and segmental lymph nodes.
RESULTS: In all evaluated bronchi (n=6), the thin CP-EBUS was able to access deeper bronchi compared to the conventional CP-EBUS owing to the diameter and larger bending angle. The endoscopic image of the thin CP-EBUS was sustained at one bifurcation deeper at tracheobronchus and left upper bronchus and 3 bifurcations deeper at the right lower lobe bronchus compared to the conventional CP-EBUS. The second curvature point was helpful for insertion of the bronchoscope into the upper lobe. Adequate lymph node sampling from lobar and segmental lymph nodes was possible using the aspiration needle.
CONCLUSIONS: The thin CP-EBUS has improved accessibility to peripheral bronchi with excellent operability and is capable of sampling lobar and segmental lymph nodes using the aspiration needle.
CLINICAL IMPLICATIONS: This will allow a more precise assessment of the N1 lymph nodes during nodal staging for lung cancer.
DISCLOSURE: Kazuhiro Yasufuku: Grant monies (from industry related sources): Grant from OLYMPUS MEDICALSYSTEMS CORP. for continuing medical education and research The following authors have nothing to disclose: Hironobu Wada, Kentaro Hirohashi, Takahiro Nakajima, Takashi Anayama, Judy McConnell, Thomas Waddell, Shaf Keshavjee, Ichiro Yoshino
The prototype thin convex probe endobronchial ultrasound was provided by OLYMPUS MEDICALSYSTEMS CORP., Tokyo, Japan.