A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis

Tremblay, Alain; Stather, David R.; MacEachern, Paul; Khalil, Moosa; Field, Stephen K.

doi:10.1378/chest.08-2768

Cited by 316 publications

(280 citation statements)

References 37 publications

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“…EBUS-TBNA: endobronchial ultrasound-guided transbronchial needle aspirate; ROSE: rapid on-site evaluation; TBLB: transbronchial lung biopsy; EBB: endobronchial biopsy. ROSE have reported a diagnostic yield of 83-85% [16,19] except for one recent study which achieved a high diagnostic yield of 94% [20]. However, the purpose of our study was not to demonstrate that EBUS-TBNA with ROSE has a higher diagnostic yield compared to standard cytological processing, but rather to answer the question whether EBUS-TBNA with ROSE provides a sufficiently robust diagnostic yield to inform the bronchoscopist whether additional lymph node passes or TBLB need to be undertaken prior to the patient leaving theatre.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were excluded from the study if there were systemic symptoms, including weight loss, fever or radiological lesions suggestive of lung cancer or tuberculosis. Each patient underwent EBUS-TBNA, TBLB and EBB as a day surgery procedure, as previously described by our group [16]. Each procedure was undertaken under general anaesthesia with a laryngeal mask airway and intravenous fentanyl and propofol.…”

Section: Methodsmentioning

confidence: 99%

“…Endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA) potentially fulfils all the requirements of an ideal diagnostic test in patients with suspected sarcoidosis. Single-centre studies have reported diagnostic yields of 83-94% and complication rates of ,1% [10,[13][14][15][16][17][18][19][20]. Recent studies concluded that EBUS-TBNA in combination with TBLB and other standard bronchoscopic techniques optimises the diagnostic yield and should be considered the first-line investigation in patients with suspected sarcoidosis [10,17,19].…”

Section: Introductionmentioning

confidence: 99%

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Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

et al. 2012

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Rapid on-site evaluation (ROSE) of endobronchial ultrasound-guided transbronchial needle aspirates (EBUS-TBNA) has not been compared to final detailed cytological analysis in patients with suspected sarcoidosis.To assess the diagnostic accuracy of EBUS-TBNA with ROSE in patients with suspected sarcoidosis, a prospective two-centre study performed EBUS-TBNA with ROSE of cellular material followed by transbronchial lung biopsy (TBLB) and endobronchial biopsy (EBB). The diagnostic accuracy of EBUS-TBNA with ROSE was compared to the final cytological assessment and to TBLB and EBB.Analysis confirmed 49 out of 60 cases of sarcoidosis. ROSE sensitivity was 87.8% (specificity 91%, positive predictive value 97.7%). ROSE slide interpretation in combination with the final fixed slide and cell block preparations had a sensitivity of 91.8% (specificity 100%, positive predictive value 100%). 67% of patients were confirmed as having sarcoidosis on TBLB and 29% on EBB. Interobserver agreement between cytotechnologists and pathologists was very good (k50.91, 95% CI 0.80-1.0 and k50.91, 95% CI 0.79-1.0, respectively).EBUS-TBNA with ROSE has high diagnostic accuracy and interobserver agreement and informs the bronchoscopist in theatre whether additional diagnostic procedures need to be undertaken. EBUS-TBNA with ROSE should therefore be considered as the first-line investigation of sarcoidosis. @ERSpublications Rapid on-site evaluation of EBUS-TBNA should be first-line investigation in sarcoidosis

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

et al. 2012

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“…Additionally, numerous studies have reported the successful diagnosis of sarcoidosis by EBUS-TBNA (Garwood et al 2007;Tremblay and Stather, 2009). However, similar studies in patients with tuberculous lymphadenitis are limited (Navani et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

Şentürk¹,

Babaoğlu²,

Kılıç³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders. However, the utility of EBUS-TBNA in the diagnosis of mediastinal lymphomas is unclear. The aim of this study was to determine the diagnostic value of EBUS-TBNA in patients with suspected lymphoma. Materials and Methods: Sixty-eight patients with isolated mediastinal lymphadenopathy and suspected of lymphoma were included in the study. EBUS-TBNA was performed on outpatients under moderate sedation. The sensitivity, specificity, negative predictive value and diagnostic accuracy of EBUS-TBNA were calculated. Results: Sixty-four patients were diagnosed by EBUS-TBNA, but four patients with non-diagnostic EBUS-TBNA required surgical procedures. Thirty-five (51.5%) patients had sarcoidosis, six (8.8%) had reactive lymphadenopathy, nine (13.3%) had tuberculosis, one (1.5%) had squamous cell carcinoma, two (2.9%) had sarcoma and fifteen (22%) had lymphoma (follicular center cell, large B-cell primary, and Hodgkin lymphomas in three, two, and ten, respectively). Of the 15 lymphoma patients, thirteen were diagnosed by EBUS and two by thoracotomy and mediastinoscopy. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of lymphoma were calculated as 86.7%, 100%, 96.4%, and 97%, respectively. Conclusions: EBUS-TBNA can be employed in the diagnosis of mediastinal lymphoma, instead of more invasive surgical procedures.

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“…The clinical usefulness of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in the diagnosis and staging of lung cancer, sarcoidosis, and other causes of mediastinal and hilar lymphadenopathy has clearly been demonstrated 1, 2, 3, 4, 5. Over the past decade, there has been widespread interest in EBUS among chest physicians; however, the amount of training required to achieve competency of this procedure has not been clearly established.…”

Section: Introductionmentioning

confidence: 99%

Influence of trainee involvement on procedural characteristics for linear endobronchial ultrasound

et al. 2017

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BackgroundLinear endobronchial ultrasound (EBUS) is a safe and effective method for the diagnostic sampling of mediastinal lymph nodes. However, there is a learning curve associated with the procedure and operator experience influences diagnostic yield. We sought to determine if trainee involvement during EBUS influences procedural characteristics, complication rate, and diagnostic yield.MethodsWe performed a retrospective analysis of 220 subjects who underwent an EBUS procedure at our center from December 2012 to June 2013. Procedures were performed by six different interventional pulmonologists with substantial experience with EBUS or by a trainee under their direct supervision. Procedural characteristics and complications were recorded. Diagnostic yield and specimen adequacy were compared between groups.Results EBUS was performed in 220 patients with a trainee involved (n = 116) or by staff physician alone (n = 104). Patient characteristics, and the number and size of lymph node stations sampled were similar. EBUS duration was longer (16.0 vs. 13.7 minutes; P = 0.002) and the total dose of lidocaine used was higher (322.3 vs. 304.2 mg; P = 0.045) when a trainee was involved. The rate of adequate specimens sampled was comparable between the groups (92.0 vs. 92.0%; P = 0.60). Diagnostic yield was lower when a trainee was involved in the EBUS procedure (52.6 vs. 68.3%; P = 0.02).ConclusionTrainee involvement significantly increased EBUS duration and the dose of local anesthesia used for the procedure. Diagnostic yield was lower when a trainee was involved. Factors accounting for this difference in yield, despite adequate samples being obtained, warrant further investigation.

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A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis

Cited by 316 publications

References 37 publications

Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

Influence of trainee involvement on procedural characteristics for linear endobronchial ultrasound

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