Author of

• 11856

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  P2.17 - Poster Session 2 - Bronchoscopy, Endoscopy (ID 183)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Pulmonology + Endoscopy/Pulmonary
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11859

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    P2.17-003 - Early experience of endobronchial ultrasound-miniprobe (EBUS-MP) for investigation of peripheral pulmonary mass lesions (ID 1060)

    09:30 - 09:30  |  Author(s): K.M. Skwarski
    • Abstract

    Background
    The frequency of detection of peripheral pulmonary mass lesions is rising with increasing availability of radiological imaging. Their aetiology may need to be established, particularly in cases of suspected malignancy. Traditional means of obtaining tissue include CT-guided biopsy, bronchoscopic biopsy, endoscopic ultrasound with fine needle aspiration and surgery. Each modality has potential complications. Endoscopic ultrasound miniprobe (EBUS-MP) is established as a valuable tool, particularly in the staging of early GI tumours. EBUS-MP has been used for qualitative assessment of bronchial structures post lung transplant but data is sparse regarding the role of EBUS-MP sampling of peripheral pulmonary mass lesions. The paper illustrates our experience with this technique to date.

    Methods
    Procedures were carried out in a tertiary respiratory centre over 18 months. Patients were referred for suspected pulmonary malignancy. CT images for each case were reviewed prior to selection. All procedures were undertaken by the same consultant bronchoscopist, assisted by a respiratory trainee. Samples (biopsies / endobronchial brushings / washings) were taken from the identified subsegmental bronchus. Each case was reviewed with respect to diagnostic rate, management, complications and potential alternative non-surgical investigations.

    Results
    45 EBUS-MP procedures were performed on 43 patients. Age range 40 – 87 years (mean 69.2 years +/- 10.8). FEV1 ranged from 0.8L to 3.3L. Lesions from all lobes were targeted. No complications occurred in study population. Figures 1 and 2 show detailed outcomes for EBUS-MP. Figure 1 Figure 2

    Conclusion
    EBUS-MP is a relatively novel technique in bronchoscopy. Our early experience has demonstrated some potential usefulness of the procedure. EBUS-MP allows good visualisation of lesions, can deliver a tissue diagnosis and provide reassurance. No complications have occurred to date. We believe that EBUS-MP sampling may have a role in investigation of peripheral pulmonary mass lesions. In a well selected cohort of patients it appears to be a safe alternative to CT-guided biopsy.

  • 11860

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    P2.17-004 - Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA) Investigation of Mediastinal Lymphadenopathy of Unknown Aetiology (ID 1615)

    09:30 - 09:30  |  Author(s): K.M. Skwarski
    • Abstract

    Background
    Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) now offers an accurate and minimally invasive alternative to cervical mediastinoscopy for the pathological assessment of mediastinal and hilar lymphadenopathy. We aimed to establish amongst patients with mediastinal and hilar lymphadenopathy of unknown aetiology and without a radiological identified primary tumour; the yield from EBUS-TBNA for benign and malignant pathologies and the requirement for subsequent investigations in order to confirm a pathological diagnosis in non diagnostic TBNA samples.

    Methods
    We retrospectively reviewed 418 endobronchial ultrasound examinations performed between 03/01/2011 and 01/03/2013 at the Royal Infirmary of Edinburgh. All patients had a pre-sampling CT thorax and a maximum lymph node diameter of > 10mm. All cases without a radiological identified primary were included in the study. Final clinical diagnosis in relation to pathological diagnosis was achieved from the medical records as was the need for further investigations in order to achieve a pathological diagnosis.

    Results
    Of 418 EBUS procedures 340 were to stage lymph nodes with radiological primary lesion. 78 EBUS procedures were performed for the investigation of lymphadenopathy of unknown origin. Nodal sampling was achieved in 112 of 118 aspirates (95%). 32 patients (41%) had non diagnostic lymph node sampling. 72 (35.1%) had malignancy diagnosed by EBUS-TBNA (21 bronchogenic) with a further 5 suspicious of malignancy. A false negative for malignancy occurred in 1 patient who had lymphoma. Of 19 patients with a clinical suspicion of sarcoidosis 14 had non-caseating granulomatous lymphadenitis confirmed on TBNA and 3 patients had subsequent confirmation with invasive investigations. The yield then of EBUS FNA for sarcoidosis was 88% when considering those with subsequent pathological confirmation. Of 24 patients with negative sampling, 10 were considered reactive to underlying lung disease, although 11 remained without clear explanation. Follow up was variable within this group. 9 patients required further investigations to confirm disease. 3 patients required mediastinoscopy and 2 went on to have endoscopic ultrasound with core biopsy

    Conclusion
    EBUS-TBNA has an excellent yield for both begin and malignant pathologies causing mediastinal lymphadenopathy and should be considered as a non invasive alternative to mediastinoscopy where lymphoma is thought less likely.Where TBNA or FNA is non-diagnostic but the suspicion of malignancy is high, further investigations are indicated. Given the availability of CT scanning in today’s practice, lymphadenopathy of uncertain significance is an increasing clinical dilemma. Protocols have had to be developed for the management of incidental solitary pulmonary nodules and similar guidelines could be produced for the management of intra-thoracic lymphadenopathy incidental or otherwise to ensure a standardised investigative cycle and follow up.