Endobronchial Ultrasound-Guided Transbronchial Needle
Aspiration for the Diagnosis of Central Intrapulmonary Lesions not Visible by Conventional Bronchoscopy
Sataporn Chaiyakul MD 1
Affiliation : 1 Department of Medicine, Vachira Phuket Hospital, Phuket, Thailand
Background : The diagnosis of the central intrapulmonary lesion is technically challenge. Endobronchial ultrasound-guided
transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosis of mediastinal lesion and staging before lung cancer surgery.
The usefulness of EBUS-TBNA for central intrapulmonary lesion will be evaluated.
Objective : To evaluate the diagnostic performance and safety of convex probe endobronchial ultrasound-guided transbronchial
needle aspiration (EBUS-TBNA) for the diagnosis of central intrapulmonary lesion and the usefulness of rapid on-site evaluation
for samples taken during EBUS-TBNA.
Materials and Methods : The present prospective cross-sectional study was conducted to enroll 175 patients with central
intrapulmonary lesions underwent EBUS-TBNA at Vachira Phuket Hospital from June 2013 to May 2017. The diagnostic yield,
sensitivity, specificity, PPV, NPV, diagnostic accuracy and associated factors were analyzed.
Results : EBUS-TBNA was performed to 175 patients with central intrapulmonary lesion. The overall diagnostic yield of EBUS-TBNA
was 90.3%. The diagnostic yield in the benign lesion was 82.1% and malignant lesion was 91.8%. The sensitivity, specificity, PPV,
NPV, and diagnostic accuracy for detecting intrapulmonary lesion were 91.8%, 100%, 100%, 70%, and 91.4%, respectively. Rapid
on-site evaluation (ROSE) was available in 52 patients. ROSE was the most important factor that helped enhance EBUS-TBNA
diagnostic accuracy ( p = 0.005). A logistic regression analysis revealed that heterogenous echogenicity and ill-defined margin from
EBUS image were predictive factors for malignant lung lesion with the hazard ratio of 26.136 ( p <0.001) and 3.947 ( p = 0.001),
respectively. The availability of ROSE resulted in a significant reduction in the number of passes per lesion (mean: 3.40±0.66 vs
6.07±1.34, p <0.001) and the duration of procedure (mean: 32.33±6.50 vs 50.32±4.99, p <0.001). The cytologic result from ROSE
was false negative in 2 samples with the sensitivity and specificity were 92% and 100%, respectively.
Conclusion : EBUS-TBNA is an effective and safe procedure for the diagnosis of central intrapulmonary lesion not visible by
conventional bronchoscopy. It is minimally invasive and improves the diagnostic performance.
Keywords : Endobronchial ultrasound-guided transbronchial needle aspiration, Central intrapulmonary lesion, Rapid on-site
evaluation, Convex probe endobronchial ultrasound
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