The real value of endobronchial ultrasound

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure worldwide, used in conjunction with bronchoscopy to obtain biopsies for mediastinal disorders. We describe a case where EBUS-TBNA was pivotal in reducing the number of invasive procedures in a patient with metastatic supraglottic carcinoma. Case reportA 67-year-old man with a 40 pack-year smoking history presented with a 2-year history of hoarseness and weight loss. He also had a history of asbestos exposure. On examination under anaesthesia a lesion of the right false vocal fold was found and histology showed a moderately differentiated infiltrating keratinising squamous carcinoma. A subsequent computed tomography (CT) scan provisionally staged his supraglottic carcinoma as T 2 N 0 M 0 and he underwent radical treatment with external beam radiation therapy, to which he responded well. He had been attending our clinic regularly and remained well, but on a visit 4 years later possible recurrence was considered -with hilar lymphadenopathy noted on his chest radiograph. On the CT scan of his chest there was a heterogenously enhancing soft-tissue mass (42 mm × 30 mm) in the posterior segment of the left upper lobe, adjacent to the proximal descending thoracic aorta, with a tissue plane between the mass and mediastinal structures appreciated. The mass demonstrated encasement of the left main pulmonary artery (Fig. 1). There was also a left diaphragmatic calcified plaque. The question posed was whether this mass could be ascribed to metastatic supraglottic carcinoma or if it was indeed a metachronous primary bronchus carcinoma, as the treatment of these two malignancies differs significantly. Considering traditional bronchoscopy with TBNA as the least invasive procedure to obtain a cytological diagnosis, the proximity of the aorta and pulmonary arteries and the mass being 14 mm from the bronchus would have made sampling by means of this procedure near impossible. With the assistance of EBUS the mass was localised, despite it not abutting the bronchus, and the position of the major vessels duly noted on Doppler ultrasound. Under real-time ultrasound guidance (Fig. 2 Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure worldwide, used in conjunction with bronchoscopy to obtain biopsies for mediastinal disorders.A 67-year-old man with a 40 pack-year smoking history presented with a 2-year history of hoarseness and weight loss. He also had a history of asbestos exposure. On examination under anaesthesia a lesion of the right false vocal fold was found and histology showed a moderately differentiated infiltrating keratinising squamous carcinoma. The question posed was whether this mass could be ascribed to metastatic supraglottic carcinoma or if it was indeed a metachronous primary bronchus carcinoma, as the treatment of these two malignancies differs significantly. Traditional bronchoscopy with TBNA is the least invasive procedure to obtain a cytological diagn...