SESSION TITLE: Bronchoscopy Poster Discussions
SESSION TYPE: Original Investigation Poster Discussion
PRESENTED ON: Wednesday, October 28, 2015 at 11:00 AM - 12:15 PM
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recognized, minimally invasive diagnostic and staging tool in the investigation of neoplasia. We aimed to describe the indications and performance of EBUS-TBNA in the evaluation of malignancy.
METHODS: We retrospectively reviewed the charts of 240 patients who had EBUS procedures between January 2013 and December 2014 in our center. Efficacy of EBUS-TBNA was assessed in terms of providing specific diagnosis and precise subtyping of lung cancer.
RESULTS: Mean age of patients was 67 years old (range 27-89), with 133(55.4%) males. Prior to EBUS, 87(36.3%) cases had a non diagnostic bronchoscopy and 17(7.1%), a non diagnostic transthoracic biopsy. The indication for EBUS procedure was: diagnostic and staging in 197(82.1%), staging of diagnosed lung cancer in 19(7.9%), evaluation of recurring lung cancer in 12(5.0%) and staging of other cancer in 12(5.0%). A specific diagnosis was established with EBUS procedure in 159(66.3%), with 141(58.8%) lung cancers [77/141(54.6%) adenocarcinoma, 32(22.7%) squamous, 4(2.8%) large cells, 7(5.0%) undifferenciated carcinoma, 16(11.3%) small cells, 2(1.4%) carcinoid and 3(2.1%) not specified]. Higher diagnostic yield was obtained with central (inner 2/3) location of principal lesion (69.2% vs 30.8%, p<0.001), bronchus sign (75.5% vs 59.0%, p=0.007) and short axis of largest lesion >20mm (68.6% vs 42.3%, p=0.008). EBUS-TBNA was performed on a total of 585 lymph node stations (173 hilar and 412 mediastinal). Adequate sampling with presence of lymphocytes was obtained in 475(81.2%), and pathological findings compatible with a specific diagnosis were found in 214(36.6%). Higher number of passes (>3) was associated with better diagnostic yield (52.4% vs 33.2%, p<0.001). Core biopsy material with EBUS-TBNA was obtained in 79/585(13.5%), providing a specific diagnosis in 44/79(55.7%). Compared to cytology alone, the addition of core biopsy significantly improved the diagnostic yield (55.7% vs 33.6%, p<0.001).
CONCLUSIONS: EBUS proved to have an interesting diagnostic value for malignancy, while a prior standard bronchoscopy was non diagnostic in more than one-third of our cohort. Lymph node EBUS-TBNA provided higher diagnostic yield when core biopsy was taken along with cytology sampling.
CLINICAL IMPLICATIONS: EBUS-TBNA should be considered as a first diagnostic and staging procedure for suspected lung cancer. Core biopsy material should be obtained from lymph nodes in addition to cytology samples.
DISCLOSURE: The following authors have nothing to disclose: Ping Shi Zhu, Thomas Vandemoortele
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