Hanyang Med Rev.  2014 Feb;34(1):20-25. 10.7599/hmr.2014.34.1.20.

The Role of EBUS-TBNA in the Diagnosis and Staging of Lung Cancer

• Um SW

• KMID: 2168309
• DOI: http://doi.org/10.7599/hmr.2014.34.1.20

Abstract

Convex-probe endobronchial ultrasound-guided transbronchial needle aspiration (CP-EBUS-TBNA) has emerged as a new diagnostic modality that allows ultrasound-guided, real-time needle aspiration of mediastinal and hilar lymph nodes. Mediastinoscopy has been the reference standard for neoplastic staging in the mediastinum, but it is invasive and requires general anesthesia. Considering recent prospective studies and clinical guidelines, a needle technique such as EBUS-TBNA and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) should be performed first for the mediastinal nodal staging of non-small lung cancer. Combining EBUS-TBNA and EUS-FNA will replace more invasive methods such as mediastinoscopy. CP-EBUS-TBNA can also be used for the restaging after neoadjuvant therapy, the diagnosis of recurrent lung cancer and central lung parenchymal lesion which abuts trachea or bronchi. In the era of personalized medicine, good-quality and sufficient tissues need to be obtained for the molecular testing and treatment guidance. EBUS-TBNA has the ability to obtain satisfactory material for the detection of EGFR mutation, KRAS mutation, and EML-ALK fusion gene.

Keyword

Endoscopic Ultrasound-Guided Fine Needle Aspiration; Lung Neoplasms; Mediastinum; Lymph node; Neoplasm Metastasis

MeSH Terms

Anesthesia, General
Bronchi
Diagnosis*
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Lung Neoplasms*
Lung*
Lymph Nodes
Mediastinoscopy
Mediastinum
Methods
Needles
Neoadjuvant Therapy
Neoplasm Metastasis
Trachea
Precision Medicine

Figure

• 

  Fig. 1 EBUS bronchoscope and puncture needle. (A) Tip of ultrasound puncture bronchoscope. (B) Inflated balloon with saline and 22-guaze TBNA needle.

• 

  Fig. 2 Ultrasound images of EBUS-TBNA procedures. (A) Linear ultrasound image (needle in the lymph node) is a 50° slice in parallel to the long axis of the bronchoscope. (B) Power Doppler image can differentiate the vascular shadow (PA & AO) from lymph node (4L).

• 

  Fig. 3 CP-EBUS-TBNA for the central parenchymal lung mass. (A) Lung parenchymal mass at right upper lobe which abuts the trachea. (B) Linear ultrasound image of the mass (needle in the mass).

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