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

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.

doi:10.1016/J.LUNGCAN.2008.04.004

Title

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

Author

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.

Abstract

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. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

Language

English

Source (journal)

Lung cancer: journal of the International Association for the Study of Lung Cancer / International Association for the Study of Lung Cancer [Aurora, Colo.] - Amsterdam

Publication

Amsterdam : 2009

ISSN

0169-5002

DOI

10.1016/J.LUNGCAN.2008.04.004

Volume/pages

63 :1 (2009) , p. 45-49

ISI

000262812300007

Full text (Publisher's DOI)

https://doi.org/10.1016/J.LUNGCAN.2008.04.004