Performance characteristics and predictors of yield from transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions

Trisolini, Rocco; Cancellieri, Alessandra; Tinelli, Carmine; Paioli, Daniela; Scudeller, Luigia; Parri, Sergio Nicola Forti; Livi, Vanina; Boaron, Maurizio; Patelli, Marco

doi:10.1111/j.1440-1843.2011.02026.x

Cited by 25 publications

(35 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This yield may even be enhanced by additional biopsy techniques, such as needle aspiration with or without endobronchial ultrasound [7][8][9][10][11][12], but were not included in our routine programme in an otherwise operable SPN. Bacterial pneumonia was found to be the cause of the SPN in two cases.…”

Section: Discussionmentioning

confidence: 99%

Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules

Schwarz

Schönfeld²,

Bittner

et al. 2012

Eur Respir J

View full text Add to dashboard Cite

The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons.In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin.Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n51, small cell lung cancer n51, bacterial pneumonia n52), and the surgical strategy had to be modified to bilobectomy in one patient.Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular preoperative work-up of patients with SPN.KEYWORDS: Flexible bronchoscopy, lung cancer, pre-operative evaluation, solitary pulmonary nodule T he diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. There are significant differences in the management of SPN; whereas radiologists tend to recommend short-term follow-up or needle aspiration under computed tomography (CT) guidance, pneumologists and thoracic surgeons prefer a more aggressive approach, especially in patients with a higher likelihood of malignancy [1].New pulmonary nodules have a high probability of malignancy. In the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines, studies are cited in which SPN, detected either by screening or incidentally, were malignant in 33-60% with a diameter measuring 11-20 mm and in 64-82% with a diameter measuring .20 mm [2]. Smaller pulmonary nodules less often have a malignant aetiology.The second edition of the ACCP evidence-based clinical practice guidelines recommends a very limited use of bronchoscopy (or transthoracic needle biopsy) in the management of patients who have an indeterminate SPN that measures at least 8-10 mm in diameter and are candidates for curative (surgical) treatment [3]. The reasoning against routine pre-operative bronchoscopy is that it has been shown to rarely change tumour stage and/or to contraindicate surgery [4,5].In most German specialised chest hospitals/departments, the endobronchial status is routinely evaluated pre-operatively via flexible bronchoscopy under local anaesthesia in order to: exclude additional endobronchial tumour manifestations; examine vocal cord function; find anatom...

show abstract

Section: Discussionmentioning

confidence: 99%

Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules

Schwarz

Schönfeld²,

Bittner

et al. 2012

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…The impact of lobar tumour location on sensitivity or negative predictive values has been sparsely investigated. A bronchoscopic study found the lowest yield when the lesion was in the most apical or basal segment (11), and a TTNAB study found the numerically lowest yield in the right upper lobe (12). The background is not known, but we speculate that the thoracic anatomy of the apical thorax restricts tumour access because of, for example, lower rib–rib distance and larger distance from skin to pleura compared to more distally located lesions.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and consequences of same-day, invasive lung cancer workup – a retrospective study in patients treated with surgical resection

Madsen

Høegholm

Bødtger

2016

European Clinical Respiratory Journal

View full text Add to dashboard Cite

BackgroundThough widely used, little is known about accuracy and efficacy of same-day, invasive workup of suspected lung cancer.ObjectiveTo evaluate the accuracy and efficacy of same-day, invasive lung cancer workup (diagnosis and mediastinal staging), and to identify differences between patients without (Group A) or with (Group B) need for resampling.MethodsA retrospective study was performed on all consecutive patients referred for surgical treatment for localised lung cancer after invasive diagnostic and staging workup at our unit. Data were extracted from electronic medical files. Surgical specimens served as gold standard for correct diagnosis and stage.ResultsA total of 129 patients (peripheral lesion: 84%; mediastinal staging: 97%) were included. After same-day, invasive workup, 71% had no need for further invasive workup (Group A), while 29% had (Group B). Group A differed significantly from Group B in fewer invasive tests, fewer days from referral to surgery, and lower pneumothorax incidence, while no differences were observed in diagnostic accuracy, cancer subtype, tumour size, tumour stage, peripheral lesion, nodal involvement, gender, or presence of chronic obstructive pulmonary disease. Tumour located in right upper lobe was associated with need for resampling.DiscussionOur retrospective study suggests that same-day, invasive workup for lung cancer is safe, accurate, and efficacious in reducing time to therapy, even in patients with small lesions and low tumour burden.

show abstract

“…[12][13][14] The strength of TBNA is that it showed higher sensitivity than transbronchial biopsy, especially in cases with lesions lacking bronchus sign. 15,16) Adding TBNA to conventional EBUS diagnostic procedures has demonstrated a potential for good …”

Section: Discussionmentioning

confidence: 99%

Transbronchial Needle Aspiration through a Guide Sheath with Endobronchial Ultrasonography (GS-TBNA) for Peripheral Pulmonary Lesions

Takai

Izumo

Chavez

et al. 2014

Ann Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Purpose: Although, endobronchial ultrasonography with a guide sheath is becoming a common procedure for the diagnosis of peripheral pulmonary lesions, there remain to be some inaccuracies in cases wherein the probe is located outside the lesion. We tested whether adding transbronchial needle aspiration through a guide sheath to the conventional technique increases efficacy for diagnosing peripheral pulmonary lesions. Methods: We performed transbronchial needle aspiration through a guide sheath for 37 subjects with peripheral pulmonary lesions between September 2012 and April 2013. The devices used were as follows (all Olympus Ltd., Tokyo, Japan): 1T-260 or LF-TP bronchoscope, K203 guide sheath kit and NA-1C-1 needle apparatus, customized by cutting the guide sheath 30 mm from the proximal end to fit well with the needle. Results: The endobronchial ultrasound probe was located within the lesion in 21 cases (56.8%) and outside in 16 cases (43.2%). Overall accuracy was 86.5 percent; 90.5% in "within" cases compared to 81.3% in "outside" cases with no significant difference (P = 0.42). Pneumothorax occurred in 2 cases and pneumonia in 1 case. Conclusion: Transbronchial needle aspiration through a guide sheath is an effective and safe diagnostic procedure for peripheral pulmonary lesions, especially when the guide sheath is outside the lesion.

show abstract

Performance characteristics and predictors of yield from transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions

Cited by 25 publications

References 26 publications

Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules

Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules

Accuracy and consequences of same-day, invasive lung cancer workup – a retrospective study in patients treated with surgical resection

Transbronchial Needle Aspiration through a Guide Sheath with Endobronchial Ultrasonography (GS-TBNA) for Peripheral Pulmonary Lesions

Contact Info

Product

Resources

About