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EBUS TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy

(2009) Lung Cancer. 63(1). p.45-49
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Abstract
Background: Obtaining a tissue diagnosis of malignancy is challenging in patients with suspected lung cancer presenting with centrally located intrapulmonary masses. Objective: (1)To evaluate the yield of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) for diagnosing centrally located lesions after a non-diagnostic conventional bronchoscopy. (2) To assess the impact of EBUS-TBNA on patient management for this indication. Study design and patients: A retrospective analysis of a series of patients with a central parenchymal lung lesion suspected to be lung cancer who had been referred to three university hospitals for EBUS-TBNA to obtain a tissue diagnosis was undertaken. If EBUS TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a transthoracic needle aspiration biopsy or a surgical diagnostic procedure. Results: Sixty patients were investigated with EBUS-TBNA. The majority (82%) had a prior (non-diagnostic) flexible bronchoscopy. EBUS TBNA was performed in an out-patient setting in 97%. With ultrasound, the primary lung lesion was observed in all cases. EBUS-TBNA confirmed lung cancer in 46 (77%). A final reference pathology diagnosis was available in 59 (98%) cases. The sensitivity of EBUS-TBNA for diagnosing lung cancer was 82% (95% confidence intervals (CI) 69-91%) with a negative predictive value of 23% (95%CI 5-53%). Based on the EBUS-TBNA findings, transthoracic needle aspiration biopsy or a surgical diagnostic procedure was cancelled in 47% and 30% of patients, respectively. No serious procedure-related complications were reported. Conclusion: EBUS-TBNA is a sensitive tool for the diagnosis of centrally located primary lung cancer not visible at conventional bronchoscopy. Therefore, EBUS-TBNA can impact on patient management in this setting. However, the low negative predictive value indicates that a negative EBUS-TBNA result should be confirmed by other methods. Implication: EBUS-TBNA can be considered as a diagnostic test in patients with a centrally located lung lesion after a previous non-diagnostic conventional bronchoscopy
Keywords
transthoracic needle biopsy, endobronchial ultransound, Lung Cancer, transbronchial needle aspiration, bronchoscopy, EBUS-TBNA

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MLA
Tournoy, Kurt, Robert Rintoul, Jan Van Meerbeeck, et al. “EBUS TBNA for the Diagnosis of Central Parenchymal Lung Lesions Not Visible at Routine Bronchoscopy.” Lung Cancer 63.1 (2009): 45–49. Print.
APA
Tournoy, K., Rintoul, R., Van Meerbeeck, J., Carroll, N., Praet, M., Buttery, R., Van Kralingen, K., et al. (2009). EBUS TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy. Lung Cancer, 63(1), 45–49.
Chicago author-date
Tournoy, Kurt, Robert Rintoul, Jan Van Meerbeeck, Nicholas Carroll, Marleen Praet, Robert Buttery, Klaas Van Kralingen, Klaus Rabe, and Jouke Annema. 2009. “EBUS TBNA for the Diagnosis of Central Parenchymal Lung Lesions Not Visible at Routine Bronchoscopy.” Lung Cancer 63 (1): 45–49.
Chicago author-date (all authors)
Tournoy, Kurt, Robert Rintoul, Jan Van Meerbeeck, Nicholas Carroll, Marleen Praet, Robert Buttery, Klaas Van Kralingen, Klaus Rabe, and Jouke Annema. 2009. “EBUS TBNA for the Diagnosis of Central Parenchymal Lung Lesions Not Visible at Routine Bronchoscopy.” Lung Cancer 63 (1): 45–49.
Vancouver
1.
Tournoy K, Rintoul R, Van Meerbeeck J, Carroll N, Praet M, Buttery R, et al. EBUS TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy. Lung Cancer. Shannon, Ireland: Elsevier Ireland LTD; 2009;63(1):45–9.
IEEE
[1]
K. Tournoy et al., “EBUS TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy,” Lung Cancer, vol. 63, no. 1, pp. 45–49, 2009.
@article{537309,
  abstract     = {Background: Obtaining a tissue diagnosis of malignancy is challenging in patients with suspected lung cancer presenting with centrally located intrapulmonary masses.
Objective: (1)To evaluate the yield of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) for diagnosing centrally located lesions after a non-diagnostic conventional bronchoscopy. (2) To assess the impact of EBUS-TBNA on patient management for this indication.

Study design and patients: A retrospective analysis of a series of patients with a central parenchymal lung lesion suspected to be lung cancer who had been referred to three university hospitals for EBUS-TBNA to obtain a tissue diagnosis was undertaken. If EBUS TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a transthoracic needle aspiration biopsy or a surgical diagnostic procedure.

Results: Sixty patients were investigated with EBUS-TBNA. The majority (82%) had a prior (non-diagnostic) flexible bronchoscopy. EBUS TBNA was performed in an out-patient setting in 97%. With ultrasound, the primary lung lesion was observed in all cases. EBUS-TBNA confirmed lung cancer in 46 (77%). A final reference pathology diagnosis was available in 59 (98%) cases. The sensitivity of EBUS-TBNA for diagnosing lung cancer was 82% (95% confidence intervals (CI) 69-91%) with a negative predictive value of 23% (95%CI 5-53%). Based on the EBUS-TBNA findings, transthoracic needle aspiration biopsy or a surgical diagnostic procedure was cancelled in 47% and 30% of patients, respectively. No serious procedure-related complications were reported.

Conclusion: EBUS-TBNA is a sensitive tool for the diagnosis of centrally located primary lung cancer not visible at conventional bronchoscopy. Therefore, EBUS-TBNA can impact on patient management in this setting. However, the low negative predictive value indicates that a negative EBUS-TBNA result should be confirmed by other methods.

Implication: EBUS-TBNA can be considered as a diagnostic test in patients with a centrally located lung lesion after a previous non-diagnostic conventional bronchoscopy},
  author       = {Tournoy, Kurt and Rintoul, Robert and Van Meerbeeck, Jan and Carroll, Nicholas and Praet, Marleen and Buttery, Robert and Van Kralingen, Klaas and Rabe, Klaus and Annema, Jouke},
  issn         = {0169-5002},
  journal      = {Lung Cancer},
  keywords     = {transthoracic needle biopsy,endobronchial ultransound,Lung Cancer,transbronchial needle aspiration,bronchoscopy,EBUS-TBNA},
  language     = {eng},
  number       = {1},
  pages        = {45--49},
  publisher    = {Elsevier Ireland LTD},
  title        = {EBUS TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy},
  url          = {http://dx.doi.org/10.1016/j.lungcan.2008.04.004},
  volume       = {63},
  year         = {2009},
}

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