Yonsei Med J.  2013 May;54(3):672-678. 10.3349/ymj.2013.54.3.672.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Central Lung Parenchymal Lesions

• Verma A
• Jeon K
• Koh WJ
• Suh GY
• Chung MP
• Kim H
• Kwon OJ
• Um SW

• KMID: 1727881
• DOI: http://doi.org/10.3349/ymj.2013.54.3.672

Abstract

PURPOSE
The purpose of this study was to evaluate the usefulness of convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for detecting malignancy in parenchymal pulmonary lesions located adjacent to the central airways.
MATERIALS AND METHODS
We retrospectively reviewed the diagnostic performance of EBUS-TBNA in consecutive patients with high clinical suspicion of a centrally located primary lung cancer who had undergone EBUS-TBNA at the Samsung Medical Center between May 2009 and June 2011.
RESULTS
Thirty-seven patients underwent EBUS-TBNA for intrapulmonary lesions adjacent to the central airways. Seven lesions were located adjacent to the trachea and 30 lesions were located adjacent to the bronchi. Cytologic and histologic samples obtained via EBUS-TBNA were diagnostic in 32 of 37 (86.4%) of patients. The final diagnosis was lung cancer in 30 patients (7 small cell lung cancer, 23 non-small cell lung cancer), lymphoma in one and malignant fibrous histiocytoma in one patient. The diagnostic sensitivity of EBUS-TBNA in detecting malignancy and detecting both malignancy and benignity was 91.4% and 86.5%, respectively. Two patients experienced minor complications.
CONCLUSION
EBUS-TBNA is an effective and safe method for tissue diagnosis of parenchymal lesions that lie centrally close to the airways. EBUS-TBNA should be considered the procedure of choice for patients with centrally located lesions without endobronchial involvement.

Keyword

Bronchoscopy; endobronchial ultrasound; transbronchial needle aspiration; lung cancer; parenchymal lesion

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/diagnosis/ultrasonography
Diagnosis, Differential
Endoscopic Ultrasound-Guided Fine Needle Aspiration/*methods
Female
Histiocytoma, Malignant Fibrous/diagnosis/ultrasonography
Humans
Lung Neoplasms/*diagnosis/ultrasonography
Lymphoma/diagnosis/ultrasonography
Lymphoproliferative Disorders/diagnosis/microbiology
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Small Cell Lung Carcinoma/diagnosis/ultrasonography
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 A representative case of EBUS-TBNA for lung parenchymal lesions. (A) CT scan of a 43-year-old male with lung cancer showing a mass in the right upper lobe adjacent to the right lateral wall of the trachea. (B) Endobronchial ultrasound image of the same lesion with the ultrasound probe placed next to the right lateral wall of the trachea. EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration.

• 

  Fig. 2 Diagnostic algorithm of study patients. EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration; BAL, bronchoalveolar lavage; EBV, Ebstein-Barr virus.

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