Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Abstract

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions(1). There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

Endobronchial ultrasound-guided transbronchial needle aspiration for thyroid cyst therapy: A case report

“…The patient tolerated the whole process well. Combined with the findings of case reports (19,20) and a small-sample retrospective study (17), we believe that needle aspiration biopsy and treatment using the EBUS technique are feasible procedures for deep lesions near the trachea. Additionally, EBUS guided needle aspiration to thyroid is useful to further determine that the condition of the patient is not the result of primary thyroid tumors or lung cancer metastasis to the thyroid (28).…”

“…As the thyroid gland is located near and anterolateral to the upper trachea, the EBUS-TBNA technique may be useful in scanning thyroid lesions and obtaining needle aspiration samples for biopsy. Various case reports (17,19) and a small-sample retrospective study (20) have been published on the application of the EBUS-TBNA technique; however, few reports are available concerning the use of this technique to diagnose thyroid cysts (21). To date, no report has been published on the application of the EBUS-TBNA technique to treat thyroid cysts.…”

Diagnóstico endoscópico de carcinoma pulmonar de célula pequeña y neoplasia folicular de tiroides

“…La toma de muestras de todas las lesiones mediastínicas conocidas en estos pacientes confirma la extensión de la enfermedad y determina la estrategia terapéutica 7 . Ante el hallazgo incidental de lesiones tiroideas mediante la PET/TC 18 F-FDG se recomienda también un diagnóstico de confirmación 8 . En el tiroides, la hipercaptación focal es más sugestiva de malignidad que la difusa, por lo que su estudio y seguimiento son fundamentales 5 .…”