EBUS-TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2009-01, Vol.63 (1), p.45-49
• Main Authors: Tournoy, Kurt G, Rintoul, Robert C, van Meerbeeck, Jan P, Carroll, Nicholas R, Praet, Marleen, Buttery, Robert C, van Kralingen, Klaas W, Rabe, Klaus F, Annema, Jouke T
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle - instrumentation; Biopsy, Needle - methods; Bronchoscopy; Bronchoscopy - methods; EBUS-TBNA; Endobronchial ultrasound; Female; Hematology, Oncology and Palliative Medicine; Humans; Lung - diagnostic imaging; Lung - pathology; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Male; Medical Oncology - methods; Medical sciences; Middle Aged; Pneumology; Pulmonary/Respiratory; Sensitivity and Specificity; Tomography, X-Ray Computed; Transbronchial needle aspiration; Transthoracic needle biopsy; Tumors; Tumors of the respiratory system and mediastinum; Ultrasonography - methods
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2008.04.004

Summary Background Obtaining a tissue diagnosis of malignancy is challenging in patients with suspected lung cancer presenting with centrally located intrapulmonary masses. Objective (1) To evaluate the yield of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) for diagnosing centrally located lesions after a non-diagnostic conventional bronchoscopy. (2) To assess the impact of EBUS-TBNA on patient management for this indication. Study design and patients A retrospective analysis of a series of patients with a central parenchymal lung lesion suspected to be lung cancer who had been referred to three university hospitals for EBUS-TBNA to obtain a tissue diagnosis was undertaken. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a transthoracic needle aspiration biopsy or a surgical diagnostic procedure. Results Sixty patients were investigated with EBUS-TBNA. The majority (82%) had a prior (non-diagnostic) flexible bronchoscopy. EBUS-TBNA was performed in an out-patient setting in 97%. With ultrasound, the primary lung lesion was observed in all cases. EBUS-TBNA confirmed lung cancer in 46 (77%). A final reference pathology diagnosis was available in 59 (98%) cases. The sensitivity of EBUS-TBNA for diagnosing lung cancer was 82% (95% confidence intervals (CI) 69–91%) with a negative predictive value of 23% (95%CI 5–53%). Based on the EBUS-TBNA findings, transthoracic needle aspiration biopsy or a surgical diagnostic procedure was cancelled in 47% and 30% of patients, respectively. No serious procedure-related complications were reported. Conclusion EBUS-TBNA is a sensitive tool for the diagnosis of centrally located primary lung cancer not visible at conventional bronchoscopy. Therefore, EBUS-TBNA can impact on patient management in this setting. However, the low negative predictive value indicates that a negative EBUS-TBNA result should be confirmed by other methods. Implication EBUS-TBNA can be considered as a diagnostic test in patients with a centrally located lung lesion after a previous non-diagnostic conventional bronchoscopy.