Pulmonary Procedures |

Transvascular EBUS-TBNA: Another Tool in the Diagnostic Assessment of Hilar Lymph Nodes and Lung Lesions FREE TO VIEW

Joseph Cicenia, MD; Tanmay Panchabhai, MD; Praveen Vijhani, MD; Francisco Almeida, MD; Thomas Gildea, MD; Michael Machuzak, MD; Peter Mazzone, MD; Sonali Sethi, MD; Atul Mehta, MD
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Cleveland Clinic, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):735A. doi:10.1378/chest.1993516
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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: To assess the safety and feasibility of transvascular EBUS-TBNA in situations where lymph nodes or lung nodules cannot be easily reached by standard bronchoscopic techniques.

METHODS: A retrospective cohort of patients undergoing EBUS-TBNA during a one year span from February 2013 to February 2014 was analyzed to identify procedures in which a mediastinal vessel needed to be traversed in order to obtain biopsy. Indication, lymph node/lung lesion size and location, rapid on-site examination (ROSE) findings, final cytologic diagnosis, and complications, were recorded.

RESULTS: Ten procedures (out of 865 EBUS procedures) in ten patients were identified during the study period. In 9/10 patients the transvascular EBUS-TBNA occured on the left side; of these nine, four were performed for a LUL nodule and five for a left hilar (station 10L) or mediastinal lymph node (station 5). The patient who had the EBUS-TBNA performed on the right side had a RML mass for which the only access was across the RML branch of the right pulmonary artery. In 9/10 there was confirmation of either lymphoid or diagnostic cells on ROSE. All 10 had a diagnostic final cytology: 7/10 had a diagnosis of malignancy, 2/10 normal lymphoid tissue, and 1/10 with necrosis (VATS revealed histoplasmosis). The average size of the target lesion was 14mm. There were no immediate or late complications, and there was no excessive bleeding after biopsy.

CONCLUSIONS: Transvascular EBUS-TBNA is feasible and safe when performed by an experienced operator. Lesions most amenable to this technique tend to occur in the aortopulmonary window (station 5 lymph nodes) or the hilum (hilar or interlobar nodes or hilar lung nodules).

CLINICAL IMPLICATIONS: Transvascular EBUS-TBNA offers an additional tool in the diagnostic armamentarium for aortopulmonary window and hilar nodes, or hilar lung nodules, that may be difficult to access with routine bronchoscopy or EBUS, or in patients who are of high risk for surgical biopsy. Based on our data, these situations are rare but do occur, and as such should be performed by experienced operators.

DISCLOSURE: Michael Machuzak: Consultant fee, speaker bureau, advisory committee, etc.: olympus america The following authors have nothing to disclose: Joseph Cicenia, Tanmay Panchabhai, Praveen Vijhani, Francisco Almeida, Thomas Gildea, Peter Mazzone, Sonali Sethi, Atul Mehta

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