Pulmonary Procedures |

Role of EBUS-TBNA in Quasi-Central Pulmonary Lesions: Moving Forward FREE TO VIEW

Shameen Salam, MD; Jordan Reynolds; Thomas Gildea; Joseph Cicenia; Sonali Sethi; Michael Machuzak; Danai Khemasuwan; Abdul Hamid Alraiyes; Atul Mehta; Francisco Almeida, MS
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Pulmonary and Critical Care, Cleveland Clinic, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):738A. doi:10.1378/chest.1994551
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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: Endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) using convex probe has been well described in the diagnosis and mediastinal staging of lung cancer. However, data regarding its utility in the diagnosis of intrapulmonary lesions has been sparse. The purpose of this study was to assess the diagnostic accuracy of EBUS-TBNA for intrapulmonary lesions. These lesions were defined as quasi central as they could not be visualized by white light bronchoscopy, but were proximal enough to be identified by convex-probe EBUS scope.

METHODS: A retrospective analysis of EBUS-TBNA sampling of quasi-central pulmonary lesions among patients presenting between December 2008 and March 2014 was done. Patients with endobronchial lesions were excluded.

RESULTS: Seventy-seven patients underwent EBUS-TBNA of 79 intrapulmonary lesions. Lesions locations: right upper lobe 25, right middle lobe (4), right lower lobe (25), left upper lobe (12) and left lower lobe (13). The average size of the pulmonary lesions was 2.7 cm. The majority (96%) of the lesions were either abutting or encasing the airway. The average distance of non-abutting lesions was approximately 6 mm. The following diagnosis were obtained: lung cancer (69%), metastases (6%), lung abscess (5%), carcinoid (2.5%), and 1% each for sarcoma, lymphoma and a soft tissue tumor. Inadequate sampling was obtained in 2 cases. In both cases, the lesions were not identified on the ultrasound and random samples were obtained. In 8 cases (15%) a definitive diagnosis was not obtained. Of these 8 patients, 6 patients improved on antibiotics for presumed pneumonia or follow up imaging showed regression of the pulmonary lesion. One patient underwent a lobectomy and was diagnosed with mucoepidermoid carcinoma and another patient underwent a repeat EBUS-TBNA that revealed lung cancer. There was one complication of bleeding. The overall sensitivity, diagnostic accuracy and negative predictive value for any intrapulmonary lesion was 89 %, 90%, 75% respectively and for lung cancer was 96%, 97% and 91% respectively.

CONCLUSIONS: To our knowledge this is the largest study analyzing the utility of EBUS-TBNA in the diagnosis of quasi-central pulmonary lesions. EBUS-TBNA has excellent diagnostic accuracy for lesions (specifically for lung cancer) abutting the airway. EBUS-TBNA should also be considered in non-abutting lesions within 10 mm.

CLINICAL IMPLICATIONS: EBUS-TBNA plays a significant role in the evaluation of quasi-central pulmonary lesions.

DISCLOSURE: The following authors have nothing to disclose: Shameen Salam, Jordan Reynolds, Thomas Gildea, Joseph Cicenia, Sonali Sethi, Michael Machuzak, Danai Khemasuwan, Abdul Hamid Alraiyes, Atul Mehta, Francisco Almeida

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