The utility and safety of linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the paediatric population

Abstract

guided transbronchial needle aspiration (EBUS-TBNA) in adults is an essential tool for investigating mediastinal and hilar lymphadenopathy. It is now integral to the diagnostic and staging algorithm for lung cancer [1], as well as the diagnosis of other malignancies, lymphoma and non-malignant granulomatous conditions, such as sarcoidosis and tuberculosis. The comparable diagnostic yield, along with decreased complications, has reduced the requirement for previously standard surgical biopsy sampling [2,3].There remains a paucity of data on convex probe (linear) EBUS in paediatric populations [4, 5] and no large European case series. The pathology in paediatric patients is distinct from adults due to the absence of lung cancer and logistical challenges, such as patient tolerance and scope diameter. We hypothesised that EBUS can be performed safely in the paediatric population and provide diagnostic material, obviating the need for more invasive procedures in most cases. The purpose of our study was to review the utility, safety and outcomes of paediatric EBUS in our centres.A retrospective review of prospectively maintained bronchosopy and cytology databases was performed at two UK centres, Manchester Royal Infirmary and Guys and St Thomas's Trust, between May 2008 and November 2018. Cases aged ⩽18 years at time of procedure were included.Procedures were performed by operators with experience of ⩾200 EBUS procedures in adults. EBUS-TBNA was performed using a standard EBUS bronchoscope (BF-UC180F-OL8, Olympus, Tokyo, Japan or EB-530US, Fujifilm, Japan). Lymph nodes were sampled using 22-guage needles employing a two-person technique, with a dedicated bronchoscopist but separate needle handler and labelled using the International Association for the Study of Lung Cancer lymph node map. Rapid on-site evaluation (ROSE) was used for all procedures, with consultant cytopathologist feedback on adequacy of lymph node sampling and preliminary diagnosis including presence of granuloma. All material was sent for microbiological analysis, including acid-fast bacilli (AFB).Medical and anaesthetic records were reviewed for patient's demographics, ethnicity, indication for the procedure, final diagnosis, sedation, ventilation and any additional procedures or complications. Procedure, cytology and microbiology reports were reviewed to determine nodes sampled, nodal size, number of passes, immediate complications, as well as sample adequacy, cytology diagnosis, AFB stains and tuberculosis (TB) culture. Cases were considered to have a final diagnosis of TB if either culture positive or "clinically confirmed TB" if culture negative with granuloma on cytology and clinical response to TB treatment. Major complications were defined as death, bleeding requiring transfusion, advanced intervention or vasopressors, need for reversal agents, pneumothorax, mediastinitis or need for level 2-3 care.All cases undergoing the procedure under general anaesthesia utilised a laryngeal mask airway size 4 or 5 performed with paediatric anaesthetists ...

Efficacy and safety of EBUS‐TBNA and EUS‐B‐FNA in children: A systematic review and meta‐analysis

“…The sampling adequacy of EBUS TBNA/EUS‐B‐FNA in various series ranged from 92% to 100%. The sampling adequacy rates were available for four of the five studies (134 patients) 11,12,14,15 . The overall pooled sampling adequacy was 98% (95% CI, 92%–100%).…”

“…The most frequently sampled lymph node stations were subcarinal (station 7) and lower right paratracheal (station 4R). ROSE was performed in three of the five studies 11,12,15 . The mean procedure duration was 20 min (range: 18–30 min) 14 …”

“…These five case series (including 164 children) were included in the meta-analysis for calculation of the pooled summary statistics for diagnostic yield and sampling adequacy. [11][12][13][14][15] In all, a total of 173 patients underwent EBUS-TBNA/EUS-B-FNA.…”

A mysterious cause of chronic cough

“…However, if sufficient an EBUS-TBNA done at an earlier stage could have prevented the progression of her disease to involve the pituitary gland. This procedure is well described in childhood [5,6] including as a diagnostic aid in childhood sarcoidosis [7].…”

“…This may have meant we could have treated the child earlier, and prevented progression of disease. EBUS-TBNA can be safely performed in childhood [5,6] and has a high diagnostic yield in sarcoidosis [7].…”