Peripheral Located Masses and the Role of Ebus-Tbna and Eus-B-Fna

Abstract

The diagnosis of centrally located masses without endobronchial abnormalities pose a diagnostic challenge. Different modalities are applicable for tissue diagnosis. To asses the feasibility and diagnostic yield of EBUS-TBNA and EUS-B FNA in centrally located tumors adjacent to the trachea and oesophagus in patients without general anaesthesia. METHODS: Retrospective study of patients suspected of lung cancer with CT scan of chest revealing a intrapulmonary mass near or adjacent to oesophagus and trachea from January 2018 to December 2019. Patients after non diagnostic flexible bronchoscopy were proceeded to EBUS-TBNA and EUS-B-FNA for histologic diagnosis in one session by a single pulmonologist. The yield and sensitivity of EBUS-TBNA and EUS-B-FNA with also the added value of EUS-B-FNA to bronchoscopy and EBUS was assessed RESULTS: 12 patients were enrolled in the study in whom there was a centrally located tumor near the oesophagus or trachea on chest CT and histologic diagnosis was made through EBUS-TBNA or EUS-B FNA without general anaesthesia. 11 patients were identified with the following diagnosis of NSCLC. The diagnostic yield and sensitivity of EBUS and EUS-B FNA for detecting lung cancer was 91.7%. In 5 patients (41.6 %) the intrapulmonary tumor was exclusively detected by EUS-B FNA after non diagnostic bronchoscopy and EBUS-TBNA. In 6 patients (50 %) were diagnosed with trans tracheal EBUS. No EUS-B FNA complication were observed. 5 patients 41.6% after non diagnostic EBUS due to difficulty in passing the bronchoscope through the vocal cords, respiratory insufficiency, compression of the trachea due to mass and also not possible to pass the needle through the trachea were switched in during the procedure to EUS-B-FNA. EUS-B-FNA increased the yield of diagnosis from 41.6% to 91.7%. Samples were adequate for diagnosis in 91.7% of cases CONCLUSIONS: EUS-B-FNA is a feasible and safe technique for diagnosis of centrally located intrapulmonary masses. EUS-B should be considered in the same endoscopy session following a non diagnostic bronchoscopy and EBUS-TBNA. Awake EBUS-TBNA and EUS-B are a safe well tolerated procedure and can be done without general anaesthesia. When there is EBUS failure EUS-B should be considered as a alternative. CLINICAL IMPLICATIONS: EBUS-TBNA and EUS-B FNA might present the first diagnostic step in intrapulmonary masses.