Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations

Abstract

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.

Comments and Illustrations of Ultrasound Findings in Extrapulmonary Tuberculosis Manifestations

“…Mediastinal lymph nodes can be biopsied using EUS-or EBUS-guided FNA or FNB. Via paraoesophageal, paragastric, and paraduodenal access, histological specimens can be obtained from further lymph nodes using EUS-guided sampling [41,43,[45][46][47][48][49][50] [Figure 2a-m]. The most important differential diagnoses are metastases of malignant tumors, non-Hodgkin's and Hodgkin's disease and other infections.…”

“…Mediastinal lymph nodes can be biopsied using EUS-or EBUS-guided FNA or FNB. Via paraoesophageal, paragastric, and paraduodenal access, histological specimens can be obtained from further lymph nodes using EUS-guided sampling [41,43,[45][46][47][48][49][50] [Figure 2a-m The lymph nodes are visualized between the markers. In the EUS, paragastric lymph nodes are enlarged, rounded, very hypoechoic, with hypoechoic central parts, and forming conglomerates.…”

Successful Retrieval of a Broken Aspiration Needle Penetrated into the Right Pulmonary Artery: A Case Report with Experience Sharing

“…Due to its excellent performance and high diagnostic accuracy, it has been increasingly used in the clinic to evaluate lesions in the mediastinal, hilar, and peribronchial areas [2]. EBUS-TBNA is a safe procedure with fewer complications, such as bleeding, infection, pneumothorax, and hypoxia [3]. Very rarely, iatrogenic complications, such as equipment failure with needle fracture, were described in case reports [4].…”