Endobronchial Ultrasonography: Current Status and Future Directions

Endobronchial ultrasonography (EBUS) has emerged as a new diagnostic tool that allows the bronchoscopist to see beyond the airway. The radial probe EBUS was first introduced to evaluate the airway structure, which has been shown to be useful for identifying the extent of tumor invasion in the central airway. With advance in technology, smaller radial probes are now available that are capable of visualizing peripheral lung nodules. EBUS is also used as a tool to assist in a biopsy in respiratory diseases. The radial probe EBUS–guided transbronchial needle aspiration (TBNA) increases the yield of TBNA of mediastinal processes. By the use of the ultra-miniature probe EBUS along with the guide sheath, peripheral lung lesions can be accessed without the exposure to radiation. However, it is still not a real-time procedure with target visualization. The newest development is the convex probe EBUS (CP-EBUS) with a curvilinear electronic transducer on the tip of a flexible bronchovideoscope. CP-EBUS allows real-time EBUS-guided TBNA. Although the main indication for EBUS-TBNA is lymph node staging, it can also be used for diagnosis of intrapulmonary tumors, of unknown hilar and/or mediastinal lymphadenopathy, and of mediastinal tumors. To date, there are no reports of complications related to EBUS-guided TBNA. It is a novel approach that has a good diagnostic yield with excellent potential in assisting safe and accurate diagnostic interventional bronchoscopy. The aim of this review is to highlight the current status of the different EBUS techniques available and to discuss the future direction of EBUS.     

液基细胞病理检测结合经支气管针吸活检在非小细胞肺癌分期中的临床应用

目的 探讨液基细胞病理检测（LCT）结合经支气管针吸活检（TBNA）在非小细胞肺癌（NSCLC）纵隔淋巴结分期中的应用价值。方法 回顾性分析2011年8月至2013年12月在宝鸡市中心医院经常规电子支气管镜检查组织学确诊并最终行手术切除的NSCLC患者96例。术前均行TBNA纵隔淋巴结分期,穿刺物分别行常规涂片（CS）法与LCT法处理;全组患者均行肺癌根治切除术及淋巴结清扫术,分析LCT法检测结合TBNA对NSCLC术前纵隔淋巴结分期的准确率。结果 96例患者经TBNA检查7个部位共258组淋巴结, TBNA穿刺成功519针。 LCT法检测219组淋巴结阳性,阳性率为84.88%（219/258）,高于CS法检测的54.65%（141/258）,差异有统计学意义（P<0.05）。LCT法纵隔淋巴结分期的准确率为93.75%（90/96）,高于CS法的62.5%（60/96）,差异有统计学意义（P<0.05）。96例患者均能耐受并成功完成TBNA,未出现大出血、纵隔感染等并发症。结论 LCT法结合TBNA能有效提高NSCLC纵隔淋巴结分期的准确率,值得临床推广应用。     

经支气管针吸活检在肺癌分期中的作用

目的 探讨经支气管针吸活检（TBNA）在肺癌分期中的临床应用价值。方法 对42例肺癌手术前X线和/或胸部CT疑有淋巴结转移的病例行TBNA并与手术后病理检查结果进行对比。结果 术前经TBNA证实N2淋巴结癌转移10例，术后病理检查全为N2阳性且与术前TBNA检查结果相符，术前经TBNA证实N1癌转移19例，术后病理阳性22例，TBNA假阴性3例，术前经TBNA后c-TNM分期与p-TNM分期对比正确率达85.7%(36/42)。全组仅有3例患者接受TBNA后有少量咯血，无气胸及其他严重并发症发生。结论 经TBNA进行肺癌分期方法简便，经济实用，其分期正确率高，有较高的临床应用价值。     

经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值

目的 探讨经支气管针吸活检术(TBNA)联合超声内镜引导下经食管细针穿刺活检术(EUS-FNA)在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值.方法 对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS-FNA,穿刺标本均行病理和细胞学检查.结果 联合应用TBNA和EUS-FNA的诊断率为89.9%(116/129),其中行TBNA 59例,诊断率为84.7%(50/59);行EUS-FNA 70例,诊断率为94.3%(66/70).细胞学和病理学诊断率分别为92.2%(107/116)和87.9%(102/116).通过病理检查,可使诊断率提高8.4%(9/107).116例通过穿刺诊断的患者中,有103例患者得到明确组织分型,细胞学和病理组织分型诊断率分别为73.8%(76/103)和89.3%(92/103).通过病理检查,可使组织分型诊断率提高35.5%(27/76).结论 联合应用TBNA和EUS-FNA能扩大穿刺技术对纵隔肺门病变的诊断范围,提高诊断水平.病理检查可提高TBNA和EUS-FNA的诊断率和组织分型的诊断率.     

超声引导针吸活检在术前判断乳腺癌腋窝淋巴结状态中的应用

目的：研究对超声异常的腋窝淋巴结进行针吸活检的临床价值.方法：对47例cT1-2N0M0腋窝超声异常乳腺癌患者的腋窝淋巴结进行超声引导下针吸活检,结果与组织学病理结果进行对照.分析超声引导针吸活检术前判断乳腺癌腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率.结果：超声引导针吸活检判断腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为82.8%、100.0%、100.0%、78.3%、89.4%.结论：超声引导针吸活检是术前评估腋窝淋巴结状态的有效检查方法,其结果对乳腺癌手术方式的选择具有重要参考价值.     

经纤维支气管镜行支气管粘膜下穿刺活检的应用价值

目的，探讨经纤维支气管镜(纤支镜)行支气管粘膜下穿刺活检(TBNA)的应用价值。方法 对76例肺部疾病患者进行粘膜下TBNA检查。同时与刷检的组织细胞学对比分析。结果 76例患者TBNA的诊断符合率为85．5％(65／76)，刷检为55.3％(42／76)，其中TBNA对肺癌的诊断符合率为78．0％(39／50)。刷检为38．0％(19／50)。52例患者(68．4％)在穿刺部位有少量出血，其余患者均无其他严重并发症发生。结论 该技术是一种操作简便、安全、结果准确的临床实用检查手段,值得推广应用。     

F-FDG uptake predicts diagnostic yield of transbronchial biopsy in peripheral lung cancer

Objectives

Recent advances in endobronchial ultrasonography with a guide sheath (EBUS-GS) have enabled better visualization of distal airways, while virtual bronchoscopic navigation (VBN) has been shown useful as a guide to navigate the bronchoscope. However, indications for utilizing VBN and EBUS-GS are not always clear. To clarify indications for a bronchoscopic examination using VBN and EBUS-GS, we evaluated factors that predict the diagnostic yield of a transbronchial biopsy (TBB) procedure for peripheral lung cancer (PLC) lesions.

Methods

We retrospectively reviewed the charts of 194 patients with 201 PLC lesions (≤3 cm mean diameter), and analyzed the association of diagnostic yield of TBB with [¹⁸F]-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) positron emission tomography and chest computed tomography (CT) findings.

Results

The diagnostic yield of TBB using VBN and EBUS-GS was 66.7%. High maximum standardized uptake value (SUVmax), positive bronchus sign, and ground-glass opacity component shown on CT were all significant predictors of diagnostic yield, while multivariate analysis showed only high ¹⁸F-FDG uptake (SUVmax ≥2.8) and positive bronchus sign as significant predictors. Diagnostic yield was higher for PLC lesions with high ¹⁸F-FDG uptake (SUVmax ≥2.8) and positive bronchus sign (84.6%) than for those with SUVmax <2.8 and negative bronchus sign (33.3%). High ¹⁸F-FDG uptake was also correlated with tumor invasiveness.

Conclusions

High ¹⁸F-FDG uptake predicted the diagnostic yield of TBB using VBN and EBUS-GS for PLC lesions. ¹⁸F-FDG uptake and bronchus sign may indicate for the accurate application of bronchoscopy with those modalities for diagnosing PLC.     

经支气管针吸活组织检查术对肺癌的诊断价值及其安全性

目的探讨支气管针吸活组织检查术（TBNA）在肺癌诊断中的价值及其安全性。方法回顾性分析82例胸部CT提示纵隔、肺门淋巴结肿大或支气管周围肿物患者TBNA的细胞学结果。标本采用新柏氏细胞学检测。结果82例患者中TBNA阳性者43例,阳性率为52．4％。其中,小细胞癌18例,鳞癌11例,腺癌9例,未定型癌5例。39例表现为管壁外压伴黏膜改变的患者,TBNA、冲洗、刷检、钳检阳性率分别为64．1％、7．7％、25．6％、48．7％,总阳性率为76．9％。43例黏膜正常者单纯行TBNA检查,18例阳性,阳性率为41．9％。82例TBNA均未出现明显并发症。结论TBNA扩大了支气管镜的检查范畴,提高了内镜诊断阳性率,是常规支气管镜检查的重要补充手段,安全性好,值得临床进一步推广应用。     

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA): An overview and update for the cytopathologist

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) has emerged as a minimally invasive technique for evaluating the mediastinum and staging patients with lung cancer. In the hands of an experienced operator, the procedure is safe and provides excellent sensitivity, specificity, and predictive diagnostic values. In conjunction with endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA), a nearly complete mediastinal evaluation can be performed in a minimally invasive fashion. This strategy results in improved lymph node staging, markedly reduced need for mediastinoscopy, and fewer futile thoracotomies compared with a traditional surgical staging procedure. The procedure is cost effective and provides excellent cytologic specimens that have proven well suited for ancillary testing, such as immunohistochemistry and tumor genotyping. EBUS‐TBNA, initially used as a tool to sample the lymph nodes adjacent to the airway walls, has now become instrumental in sampling lesions in the mediastinum, hilum, and lung parenchyma, where previously more than 1 procedure would have been necessary. Looking forward, expanded use of this procedure is likely to revolutionize the access to cytology‐proven staging and restaging of lung cancer and other thoracic malignancies in a minimally invasive fashion. Cancer (Cancer Cytopathol) 2014;122:561–576. © 2014 American Cancer Society.     

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

BACKGROUND:

Endobronchial ultrasound (EBUS) is a relatively new modality that can be used to guide transbronchial needle aspiration (TBNA) of mediastinal and hilar lymph nodes and peripheral lung lesions. Few studies have investigated the cytological profile of EBUS‐TBNA specimens. In this study, we have reviewed the cytological profile of 135 consecutive cases, including 71 lymph node cases, 4 lung cases, and 60 cases of both lymph node and lung sampling. Our study contains the largest number of cases in the evaluation of cytomorphology.

METHODS:

The cytological specimens were collected using an ultrasound bronchofibervideoscope with a 22‐gauge needle and core biopsies were obtained with a 19‐gauge needle. An experienced cytotechnologist performed an immediate on‐site evaluation of adequacy. An immediate assessment was given to the clinician after each pass. In many patients, multiple sites were sampled. The average slides of each case were 9.9 (median of 12), with a range from 2 to 24.

RESULTS:

Of 131 cases of lymph node sampling, 45 cases (34.6%) were diagnosed as malignant, 73 cases (55.7%) as benign process, 5 cases (3.8%) as suspicious for malignancy, and 1 case (0.8%) as atypical cells. Of the 64 cases of lung lesion sampling, 21 cases (32.8%) were diagnosed as malignant, 35 cases (54.7%) as benign process, 1 case (1.5%) as suspicious for malignancy, and 4 cases (6.3%) as atypical cells. The lymph node nondiagnostic rate was 5.3%, whereas the nondiagnostic rate for lung lesions was 4.7%. Eighty‐eight cases (65.2%, 88/135) had corresponding core biopsies (with a 19‐gauge needle) or follow‐up surgery. When histology was taken as the gold standard, the sensitivity, specificity, and positive and negative predictive values for EBUS‐TBNA were 85.0%, 100%, and 100% and 89.7%, respectively. However, when both histology and clinical follow‐up were considered together, the overall sensitivity and negative predictive values were increased to 94.7% (P < .05) and 96.6% (P < .05), respectively.

CONCLUSIONS:

This study shows that EBUS‐TBNA is an accurate and sensitive method for diagnosing and staging lung cancer. The constant challenge that we as cytopathologists are now facing is how to improve our diagnostic ability and accuracy for lung cancer. We believe that this optimal goal can be achieved with the effective use of EBUS‐TBNA sampling and collaboration with our clinical colleagues. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration versus conventional transbronchial needle aspiration

BACKGROUND:

Conventional endoscopic transbronchial needle aspiration (TBNA) is a common procedure used to obtain samples for diagnosing and staging lung lesions. Recently, endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) has been developed and increasingly used by clinicians. Clinical data suggest that EBUS‐TBNA has higher sensitivity and specificity than conventional TBNA in staging lung cancers. In this study, the authors have investigated the cytological features and compared the diagnostic yield of these procedures in lung cancer patients.

METHODS:

A computer search of the cytopathology archives at The Johns Hopkins Hospital revealed 188 EBUS‐TBNA cases (308 lymph nodes; 47 lung lesions) and 74 TBNA cases (106 lymph nodes; 44 lung lesions) over a 28‐month period. All cytological material was correlated with available corresponding surgical material.

RESULTS:

The most frequently sampled lymph nodes were stations 4R and 7 in both TBNA and EBUS‐TBNA; in addition, the EBUS‐TBNA showed a wide range of lymph node sampling. EBUS‐TBNA had a significantly lower nondiagnostic rate (8.7%) compared with TBNA (28.3%, P < .05) in staging lung cancers. In lymph node sampling, the sensitivity and specificity were 54.5% and 100% in the TBNA group and 85.2% and 100% in the EBUS‐TBNA group. In lung specimens, the nondiagnostic rates of TBNA and EBUS‐TBNA were 6.8% and 4.3%, respectively (P > .05), and the sensitivity and specificity were 78.9% and 100% in the TBNA group; and 89.5% and 100% in the EBUS‐TBNA group.

CONCLUSIONS:

Findings indicated that EBUS‐FNA cytology is an optimal modality for diagnosing and staging in lung cancer patients, in comparison to conventional TBNA. Cancer (Cancer Cytopathol) 2010. © 2010 American Cancer Society.     

EGFR mutational genotyping of liquid based cytology samples obtained via fine needle aspiration (FNA) at endobronchial ultrasound of non-small cell lung cancer (NSCLC)

Objectives

Epidermal growth factor receptor (EGFR) gene mutation status should be determined in all patients with advanced, non-squamous non-small cell lung carcinoma (NSCLC) to guide targeted therapy with EGFR tyrosine kinase inhibitors. EGFR mutations are commonly tested by Sanger sequencing or allele specific polymerase chain reaction (ASPCR) on formalin-fixed paraffin-embedded (FFPE) samples including cell blocks (CB) that may fail due to absence of tumor cells. The cell pellet from cytology specimens obtained at the time of endobronchial guided ultrasound fine needle aspiration (EBUS FNA) (EBUS-TBNA, transbronchial needle aspiration) represents an alternative resource for additional tissue. Here we demonstrate the utility of using the FNA cell pellet versus for the detection of EGFR mutations in NSCLC.

Materials and methods

For internal validation, 39 cytology samples from patients with NSCLC referred for EGFR testing were analyzed using the EGFR rotor-gene Q (RGQ) PCR assay (Qiagen).Thereafter, a consecutive series of 228 EBUS FNA samples were tested.

Results

The ASPCR assay demonstrated acceptable intra-assay, inter-assay and inter-lot reproducibility, sensitivity, and specificity. For the consecutive series, only 6/228 (2.6%) failed analysis (5 due to insufficient DNA yield). Of 228 EBUS FNA cell pellets tested 32 (14.0%) demonstrated clinically relevant mutations.

Results and conclusion

ASPCR can reliably detect EGFR gene mutations in FNA preparations from patients with NSCLC obtained at EBUS.     

经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值

目的 探讨经支气管针吸活检术(TBNA)联合超声内镜引导下经食管细针穿刺活检术(EUS-FNA)在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值.方法 对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS-FNA,穿刺标本均行病理和细胞学检查.结果 联合应用TBNA和EUS-FNA的诊断率为89.9%(116/129),其中行TBNA 59例,诊断率为84.7%(50/59);行EUS-FNA 70例,诊断率为94.3%(66/70).细胞学和病理学诊断率分别为92.2%(107/116)和87.9%(102/116).通过病理检查,可使诊断率提高8.4%(9/107).116例通过穿刺诊断的患者中,有103例患者得到明确组织分型,细胞学和病理组织分型诊断率分别为73.8%(76/103)和89.3%(92/103).通过病理检查,可使组织分型诊断率提高35.5%(27/76).结论 联合应用TBNA和EUS-FNA能扩大穿刺技术对纵隔肺门病变的诊断范围,提高诊断水平.病理检查可提高TBNA和EUS-FNA的诊断率和组织分型的诊断率.     

经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值

目的 探讨经支气管针吸活检术(TBNA)联合超声内镜引导下经食管细针穿刺活检术(EUS-FNA)在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值.方法 对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS-FNA,穿刺标本均行病理和细胞学检查.结果 联合应用TBNA和EUS-FNA的诊断率为89.9%(116/129),其中行TBNA 59例,诊断率为84.7%(50/59);行EUS-FNA 70例,诊断率为94.3%(66/70).细胞学和病理学诊断率分别为92.2%(107/116)和87.9%(102/116).通过病理检查,可使诊断率提高8.4%(9/107).116例通过穿刺诊断的患者中,有103例患者得到明确组织分型,细胞学和病理组织分型诊断率分别为73.8%(76/103)和89.3%(92/103).通过病理检查,可使组织分型诊断率提高35.5%(27/76).结论 联合应用TBNA和EUS-FNA能扩大穿刺技术对纵隔肺门病变的诊断范围,提高诊断水平.病理检查可提高TBNA和EUS-FNA的诊断率和组织分型的诊断率.     

经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值

目的 探讨经支气管针吸活检术(TBNA)联合超声内镜引导下经食管细针穿刺活检术(EUS-FNA)在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值.方法 对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS-FNA,穿刺标本均行病理和细胞学检查.结果 联合应用TBNA和EUS-FNA的诊断率为89.9%(116/129),其中行TBNA 59例,诊断率为84.7%(50/59);行EUS-FNA 70例,诊断率为94.3%(66/70).细胞学和病理学诊断率分别为92.2%(107/116)和87.9%(102/116).通过病理检查,可使诊断率提高8.4%(9/107).116例通过穿刺诊断的患者中,有103例患者得到明确组织分型,细胞学和病理组织分型诊断率分别为73.8%(76/103)和89.3%(92/103).通过病理检查,可使组织分型诊断率提高35.5%(27/76).结论 联合应用TBNA和EUS-FNA能扩大穿刺技术对纵隔肺门病变的诊断范围,提高诊断水平.病理检查可提高TBNA和EUS-FNA的诊断率和组织分型的诊断率.     

经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值

目的 探讨经支气管针吸活检术(TBNA)联合超声内镜引导下经食管细针穿刺活检术(EUS-FNA)在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值.方法 对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS-FNA,穿刺标本均行病理和细胞学检查.结果 联合应用TBNA和EUS-FNA的诊断率为89.9%(116/129),其中行TBNA 59例,诊断率为84.7%(50/59);行EUS-FNA 70例,诊断率为94.3%(66/70).细胞学和病理学诊断率分别为92.2%(107/116)和87.9%(102/116).通过病理检查,可使诊断率提高8.4%(9/107).116例通过穿刺诊断的患者中,有103例患者得到明确组织分型,细胞学和病理组织分型诊断率分别为73.8%(76/103)和89.3%(92/103).通过病理检查,可使组织分型诊断率提高35.5%(27/76).结论 联合应用TBNA和EUS-FNA能扩大穿刺技术对纵隔肺门病变的诊断范围,提高诊断水平.病理检查可提高TBNA和EUS-FNA的诊断率和组织分型的诊断率.     

经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值

目的 探讨经支气管针吸活检术(TBNA)联合超声内镜引导下经食管细针穿刺活检术(EUS-FNA)在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值.方法 对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS-FNA,穿刺标本均行病理和细胞学检查.结果 联合应用TBNA和EUS-FNA的诊断率为89.9%(116/129),其中行TBNA 59例,诊断率为84.7%(50/59);行EUS-FNA 70例,诊断率为94.3%(66/70).细胞学和病理学诊断率分别为92.2%(107/116)和87.9%(102/116).通过病理检查,可使诊断率提高8.4%(9/107).116例通过穿刺诊断的患者中,有103例患者得到明确组织分型,细胞学和病理组织分型诊断率分别为73.8%(76/103)和89.3%(92/103).通过病理检查,可使组织分型诊断率提高35.5%(27/76).结论 联合应用TBNA和EUS-FNA能扩大穿刺技术对纵隔肺门病变的诊断范围,提高诊断水平.病理检查可提高TBNA和EUS-FNA的诊断率和组织分型的诊断率.     

经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值

目的 探讨经支气管针吸活检术(TBNA)联合超声内镜引导下经食管细针穿刺活检术(EUS-FNA)在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值.方法 对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS-FNA,穿刺标本均行病理和细胞学检查.结果 联合应用TBNA和EUS-FNA的诊断率为89.9%(116/129),其中行TBNA 59例,诊断率为84.7%(50/59);行EUS-FNA 70例,诊断率为94.3%(66/70).细胞学和病理学诊断率分别为92.2%(107/116)和87.9%(102/116).通过病理检查,可使诊断率提高8.4%(9/107).116例通过穿刺诊断的患者中,有103例患者得到明确组织分型,细胞学和病理组织分型诊断率分别为73.8%(76/103)和89.3%(92/103).通过病理检查,可使组织分型诊断率提高35.5%(27/76).结论 联合应用TBNA和EUS-FNA能扩大穿刺技术对纵隔肺门病变的诊断范围,提高诊断水平.病理检查可提高TBNA和EUS-FNA的诊断率和组织分型的诊断率.