The effect of 19G EBUS-TBNA biopsies on characterisation of malignant and benign disease

Jones, Rachel; Medford, Andrew R L

doi:10.1183/1393003.congress-2017.pa832

Cited by 3 publications

(4 citation statements)

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“…There was a subjective slight increase in the amount of blood on pathology analysis but not noticeably more bleeding at EBUS-TBNA. No patients required adrenaline, cold saline, transfusion or overnight stay supporting our previous patient satisfaction study for EBUS under conscious sedation and previous initial reports with the 19G needle alone [4,6].…”

Section: Discussionsupporting

confidence: 83%

“…We have previous reported superiority of the 21G needle over 22G needle in characterising benign mediastinal lesions and subcharacterising nonsmall cell lung cancer (NSCLC) in a retrospective observational study although data from other studies show conflicting results likely due to different methodologies of specimen processing and study design [2,3]. A more recent 19G EBUS-TBNA needle [4][5][6] has been developed with the potential benefits of better flexibility and larger needle size to improve diagnosis. We hypothesised the 19G biopsies would be superior to 21G and 22G in subcharacterisation of NSCLC and benign disease.…”

Section: Introductionmentioning

confidence: 99%

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The effect of 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration biopsies on characterisation of malignant and benign disease. The Bristol experience

Jones

Bhatt

Medford

2018

Monaldi Arch Chest Dis

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EBUS-TBNA is a recent mediastinal staging and diagnostic technique. We have previously reported superior characterisation with 21G biopsies over 22G biopsies for benign and malignant mediastinal nodes. A new 19G needle now exists but there are limited studies. We hypothesised 19G biopsies would improve both benign and malignant characterisation due to larger samples. We retrospectively analysed sequential patients referred for EBUS-TBNA with unexplained mediastinal adenopathy performed with 19G, 21G and 22G needles respectively (100 patients each). Contingency table analysis was performed. There were no complications. Sensitivity for malignancy was highest in the 19G group (95.7% versus 94.7% and 87.5%, respectively). The 19G group had higher mean lymph node size (19.4mm versus 18.6mm and 13.5mm, respectively), the highest proportion of lymphoma (9% versus 5% and 0%, respectively), the lowest proportion of NSCLC-NOS (2% versus 12% and 5%, respectively), the highest proportion of subcharacterised benign disease (89.6% versus 69.8% and 37.9%, respectively). This large single centre retrospective UK study suggests the 19G needle appears safe with the suggestion of better sensitivity for malignancy subcharacterisation of benign disease but this requires further study in adequately powered comparative controlled studies with univariate and multivariate analysis.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

The effect of 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration biopsies on characterisation of malignant and benign disease. The Bristol experience

Jones

Bhatt

Medford

2018

Monaldi Arch Chest Dis

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“…Otherwise, cases of chondroid hamartoma usually require either more invasive transbronchial biopsy or surgical biopsy. First experience of the use of 19G needles from other centres and our centre has demonstrated a promising diagnostic yield [8,9]. pime pime pime pime p pi im me e EDITRICE …”

Section: Discussionmentioning

confidence: 92%

Linear probe 19-gauge endobronchial ultrasound diagnosis of a benign chondroid hamartoma

Fallon

Plummeridge

Daly³

et al. 2018

Monaldi Arch Chest Dis

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We report a case of a 68-year-old gentleman, found to have a right hilar soft tissue mass whilst undergoing CT staging for prostate cancer. MRI imaging showed a heterogeneous, enhancing solid mass without evidence of fat content. A linear probe endobronchial ultrasoundguided transbronchial needle aspiration was performed using a 19G needle. This confirmed the diagnosis of a benign chondroid hamartoma, avoiding the need for more invasive surgical biopsy. Case ReportA 68-year-old gentleman with a recent diagnosis of prostate cancer was referred to the lung cancer multi-disciplinary team meeting by the uro-oncology team following a CT staging scan. The patient had no respiratory symptoms or prior respiratory history. The CT scan showed a well-defined soft tissue mass (2.9 x 2.9 x 3.3 cm) in the right lower lobe, adjacent to the posterior wall of the bronchus intermedius (Figure 1). There was no evidence of axillary, supraclavicular or mediastinal lymphadenopathy and no evidence of abdominopelvic disease elsewhere.The diagnosis of prostate cancer had been made on the basis of a raised prostate specific antigen (PSA) of 136 ug/l and a positive prostate biopsy showing grade 2 moderately differentiated adenocarcinoma. Skeletal scintigraphy showed no evidence of skeletal metastases.CT imaging raised the possibility that the lesion could be cystic in nature, and so a magnetic resonance imaging (MRI) scan of the thorax was arranged to further elucidate the structure of the lesion (Figure 2). This showed a heterogenous enhancing solid mass without evidence of fat content. It was felt that this could represent a carcinoid tumour or a metastatic lesion from prostatic carcinoma.The patient started neo-adjuvant hormonal therapy and a linear probe endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS TBNA) was performed as previously described [1]. The linear probe EBUS showed a 24mm heterogenous lesion arising from the posterior aspect of the right main bronchus, with areas of high density within a low echoic mass (Figure 3). Six biopsies were taken using an Olympus 19G needle (Olympus ViziShot, NA-U402SX-4019, Olympus KeyMed, UK), ranging from 4-10 mm in size. These samples comprised several cores of hyaline cartilage (Figure 4), together with strips of respiratory epithelium and mucus-containing macrophages. Additional adipose tissue, fibrotic stroma and oedematous stroma covered by cuboidal epithelium with bland morphology were present in the sample ( Figure 5). This combination of features was consistent with sampling of a benign chondroid hamartoma.The patient went on to have high dose rate brachytherapy and external beam radiotherapy for the prostate cancer, and continues on hormonal therapy. This PSA is now normal at 0.8 ug/l. A follow-up CT scan performed at an interval of 6 months showed no change in the size of the nodule. He remains under expectant review in the respiratory clinic and is asymptomatic from the chondroid hamartoma. Further surveillance imaging and clinical assessment is plann...

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“…Our cohort consists of a wide range of lymphoma subtypes across 23 patients, in comparison to previous 19G studies containing four or fewer patients with lymphoma. 12,[26][27][28][29] However, this series is limited by its nature as a single-centre study. The ability of our centre to facilitate ROSE of small-volume specimens by experienced pathologists mean that our results may not be generalisable to other institutions.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Diagnostic performance of 19‐gauge endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in suspected lymphoma: A prospective cohort study

Lim

Steinfort

Irving

2020

Clinical Respiratory J

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Introduction Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) represents a minimally invasive approach in the evaluation of mediastinal/hilar lymphadenopathy. Diagnostic performance of EBUS‐TBNA in lymphoma using standard 22‐gauge (22G) needle is limited by sample volumes that are often inadequate for histopathological assessment. Objectives To evaluate the diagnostic utility of 19‐gauge (19G) EBUS‐TBNA needle in the evaluation of suspected lymphoma. Methods We prospectively collected clinical and procedural information for patients undergoing EBUS‐TBNA with 19G needle at Royal Melbourne Hospital for investigation of mediastinal/hilar lymphadenopathy, where lymphoma was considered in the differential diagnosis. All consecutive patients between June 15, 2016 and July 10, 2019 were included. If definitive diagnosis was not achieved on EBUS‐TBNA, final diagnosis was determined through subsequent investigation or a minimum of 6 months radiologic surveillance. Results Thirty‐nine patients underwent EBUS‐TBNA using 19G needle for evaluation of suspected lymphoma. Thirteen patients had a prior diagnosis of lymphoma (33%). Lymphoma was ultimately diagnosed in 23 patients (59%). Of these, 10 had a prior diagnosis of lymphoma (43%). 19G EBUS‐TBNA demonstrated lymphoma in 19 patients, with a sensitivity of 83% (95% CI 66‐93) for detection of lymphoma. Four patients required surgical biopsy to definitively characterise lymphoma subtype. Therefore, sensitivity of 19G EBUS‐TBNA for definitive diagnosis of lymphoma was 65% (95% CI 45‐81). In patients with a prior diagnosis of lymphoma, sensitivity for definitive diagnosis of lymphoma was 80% (95% CI 48‐95). Conclusion Diagnostic performance of 19G EBUS‐TBNA appears similar to standard 22G needle in detection and definitive diagnosis of lymphoma. Further invasive testing remains necessary following non‐diagnostic EBUS‐TBNA procedures.

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The effect of 19G EBUS-TBNA biopsies on characterisation of malignant and benign disease

Cited by 3 publications

References 0 publications

The effect of 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration biopsies on characterisation of malignant and benign disease. The Bristol experience

The effect of 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration biopsies on characterisation of malignant and benign disease. The Bristol experience

Linear probe 19-gauge endobronchial ultrasound diagnosis of a benign chondroid hamartoma

Diagnostic performance of 19‐gauge endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in suspected lymphoma: A prospective cohort study

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