Pulmonary Procedures |

The Use of Convex-Probe Endobronchial Ultrasound Guided Biopsy in the Diagnosis of Parenchymal Pulmonary Nodules via Segmental Bronchi FREE TO VIEW

Isaac Shalom, MD; Timothy Harkin, MD
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Icahn School of Medicine at Mount Sinai Hospital, New York, NY

Chest. 2014;146(4_MeetingAbstracts):742A. doi:10.1378/chest.1990729
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SESSION TITLE: EBUS and Advanced Bronchoscopy Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The most common modalities used to diagnose parenchymal lung nodules include bronchoscopic biopsy guided by fluoroscopy, electromagnetic navigation or radial probe endobronchial ultrasound, and also CT-guided needle biopsy and surgical biopsy. The convex-probe endobronchial ultrasound bronchoscope (EBUS) is a well established tool to guide needle aspiration of central thoracic structures that abut the airways, primarily mediastinal and hilar lymph nodes, but also central parenchymal lesions. We report a series of 9 patients in which EBUS was used to accurately locate and guide transbronchial needle aspiration (TBNA) of more peripheral parenchymal pulmonary nodules (PPN) via segmental lower lobe bronchi (SB).

METHODS: Patients who underwent EBUS-TBNA of mediastinal or hilar nodes and also had attempted EBUS guided biopsy of PPN via SB with a convex probe EBUS scope (Olympus BF-UC160F-OL8) were identified by review of procedure logs. Cytology and pathology results, location of PPN, and complications were reviewed. Specimens were designated as adequate if a specific diagnosis was obtained with the EBUS specimen.

RESULTS: Since September 2013, 9 patients received 9 procedures with the intention of obtaining a TBNA of mediastinal or hilar nodes, and visualization of the PPN was attempted during the procedure. 8 PPN in the mid to outer third of the lower lobes were visualized and sampled through SB. One PPN in the outer third of the lung deep in the costophrenic sulcus could not be visualized with EBUS. The patients also underwent standard TBNA of mediastinal lymph nodes. EBUS-TBNA of PPN was adequate in 7/8 procedures, and was suspicious for carcinoma in one additional procedure. In total 5 patients were diagnosed with a malignancy (4 non-small cell lung cancer, 1 metastatic colon cancer) and 2 patients had a benign diagnosis (1 sarcoidosis, 1 MAI). In 4 procedures, EBUS-TBNA of PPN provided the only diagnostic samples. There were no complications attributable to the procedure.

CONCLUSIONS: In our experience, EBUS-TBNA of PPN via SB is a high yield and safe sampling method when the PPN can be visualized. Due to the size and limited flexibility of this bronchoscope, this technique is limited to lower lobe nodules in the mid to outer third of the lung.

CLINICAL IMPLICATIONS: EBUS-TBNA appears to be a useful and safe modality for patients with peripheral pulmonary lesions that may complement the current modalities available, especially in patients who need sampling of intrathoracic lymph nodes.

DISCLOSURE: The following authors have nothing to disclose: Isaac Shalom, Timothy Harkin

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