Endobronchial Ultrasound–guided Biopsy Is Feasible, Safe, and Improves Diagnostic Yields in Immunocompromised Children

Iyer

et al. 2020

Pediatric Pulmonology

Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and transesophageal bronchoscopic ultrasound‐guided fine‐needle aspiration (EUS‐B‐FNA) are established modalities for evaluation of mediastinal/hilar lymphadenopathy in adults. Limited literature is available on the utility of these modalities in the pediatric population. Herein, we perform a systematic review and meta‐analysis on the yield and safety of EBUS‐TBNA and EUS‐B‐FNA in children. Methods We performed a systematic search of the PubMed and EMBASE databases to extract the studies reporting the utilization of EBUS‐TBNA/EUS‐B‐FNA in children (<18 years of age). The pooled diagnostic yield and sampling adequacy (proportions with 95% confidence intervals [CIs]) were calculated using meta‐analysis of proportions using the random effects model. Details of any procedure‐related complications were noted. Results The search yielded 12 relevant studies (5 case series and 7 case reports on EBUS‐TBNA/EUS‐B‐FNA, 173 patients). Data from five case series (164 patients) were summarized for the calculation of the sampling adequacy and diagnostic yield. Safety outcomes were extracted from all publications. The pooled sampling adequacy and combined diagnostic yield of EBUS TBNA/EUS‐B‐FNA were 98% (95% CI, 92%–100%) and 61% (95% CI, 43%–77%), respectively. A procedure‐related major complication was reported in one patient (1/173, a major complication rate of 0.6%), and minor complications occurred in six patients (6/173, a minor complication rate of 3.5%). Conclusions EBUS‐TBNA and EUS‐B‐FNA are safe modalities for evaluation of mediastinal lymphadenopathy in the pediatric population. EBUS‐TBNA/EUS‐B‐FNA may be considered as the first‐line diagnostic modalities for this indication, as they have a good diagnostic yield and can avoid the need for invasive diagnostic procedures.

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of EBUS‐TBNA and EUS‐B‐FNA in children: A systematic review and meta‐analysis

Iyer

et al. 2020

Pediatric Pulmonology

“…The above describes the recent academic progress in the field of CP-EBUS diagnosis and treatment. In addition, clinical research has also confirmed the application of CP-EBUS in pediatrics (38)(39)(40)(41)(42). The next-generation CP-EBUS (BF-Y0063; Olympus Corporation, Tokyo, Japan) is also ready for use in the clinic, with a smaller probe and more flexibility (43).…”

Section: Discussionmentioning

confidence: 95%

Recent advances in convex probe endobronchial ultrasound: a narrative review

Zhou

et al. 2021

Ann Transl Med

Convex probe endobronchial ultrasound (CP-EBUS) has been widely used in the lymph node staging and restaging of lung tumors and the diagnosis of mediastinal diseases. Recent years have seen continuous progress in this technology. For diagnosis, elastography technology can preliminarily distinguish between benign and malignant lesions, so that reduce the number of punctures. CP-EBUS can also be used as an endoscopic ultrasound (EUS) to guide needle aspirations of liver lesions, retroperitoneal lymph nodes and left adrenal gland (LAG) lesions sometimes. Some advances help diagnosing more accurately and effectively, such as the intranodal forceps biopsy (IFB), the new type of 22G needle, the rapid on-site evaluation (ROSE) and the cancer gene methylation, etc. In addition, special advances are being made in diagnosis using artificial intelligence (AI). For treatment, CP-EBUS has yielded novel research results when applied to transbronchial needle injection (TBNI) and radioactive seed implantation in clinical cases, and blocking of the cardiac plexus in animal studies. The next-generation CP-EBUS is also ready for use in the clinic and the technology will be improving continuously. Through this review, we hope to educate clinicians on the latest uses of CP-EBUS and open up further research ideas for readers interested in this technology.

“…Two articles were excluded as one described utilization of EUS-B-FNA for intra-abdominal pathology, and one case report described the use of EBUS for airway wall involvement assessment in a patient with mucoepidermoid carcinoma. (8,9) Of the finally selected 12 articles, five were case series that included greater than five patients, and seven were single patient case reports (except one article that described EBUS-TBNA in two children) (10). The abstracted data of the five major case series are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of EBUS-TBNA and EUS-B-FNA in Children: A Systematic Review and Meta-analysis

Iyer

et al. 2020

Preprint

Background: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Transesophageal Bronchoscopic Ultrasound-guided fine-needle aspiration (EUS-B-FNA) are established modalities for evaluation of mediastinal/hilar lymphadenopathy in adults. Limited literature is available on the utility of these modalities in the pediatric population. Herein, we perform a systematic review and meta-analysis on the yield and safety of EBUS-TBNA and EUS-B-FNA in children. Methods: We performed a systematic search of the PubMed and EMBASE databases to extract the studies reporting the utilization of EBUS-TBNA/EUS-B-FNA in children (<18 years of age). Pooled diagnostic yield and sampling adequacy (proportions with 95% confidence intervals) were calculated using the random-effects model. Details of any procedure-related complications were noted. Results: The search yielded 12 relevant studies (five case series and seven case reports on EBUS-TBNA/EUS-B-FNA, 173 patients). Data from five case series (164 patients) were summarized for the calculation of sampling adequacy and diagnostic yield. Safety outcomes were extracted from all publications. The pooled sampling adequacy and combined diagnostic yield of EBUS TBNA/EUS-B-FNA were 98% (95% CI, 92-100%) and 61% (95% CI, 43-77%) respectively. A procedure-related major complication was reported in 1 patient (1/173, Major complication rate 0.6%), and minor complications occurred in 6 patients (6/173, Minor complication rate 3.5%). Conclusions: EBUS-TBNA and EUS-B-FNA are safe modalities for evaluation of mediastinal lymphadenopathy in the pediatric population. EBUS-TBNA/EUS-B-FNA may be considered as the first-line diagnostic modalities for this indication as they have a good diagnostic yield and can avoid the need for invasive diagnostic procedures.