Feasibility of Performing Transvascular Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration.
Aged
Aged, 80 and over
Endoscopic Ultrasound-Guided Fine Needle Aspiration
/ adverse effects
Feasibility Studies
Female
Humans
Lung Neoplasms
/ diagnosis
Lymph Nodes
/ pathology
Lymphatic Metastasis
/ pathology
Male
Mediastinal Neoplasms
/ diagnosis
Middle Aged
Neoplasm Staging
Retrospective Studies
Blood vessels
Interventional pulmonology
Lung cancer
Lung nodules
Mediastinal adenopathy
Journal
Clinical lung cancer
ISSN: 1938-0690
Titre abrégé: Clin Lung Cancer
Pays: United States
ID NLM: 100893225
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
11
05
2020
revised:
15
10
2020
accepted:
28
10
2020
pubmed:
3
2
2021
medline:
7
1
2022
entrez:
2
2
2021
Statut:
ppublish
Résumé
Thoracic vascular structures often preclude transbronchial access to central lung parenchymal lesions and lymph nodes, thereby necessitating either a surgical or transvascular needle aspiration (TVNA) approach for diagnostic sampling. The aim of this study was to evaluate the safety and efficacy of endobronchial ultrasound (EBUS) TVNA in the diagnosis and staging of mediastinal tumors. We performed a retrospective analysis of 35 cases of EBUS-TVNA. Cases were reviewed in the Cerner electronic medical records between March 2013 and October 2018. Records were reviewed for patient comorbidities, smoking status, anticoagulation intake, procedural details, sample results, and postprocedural complications. Thirty-five EBUS-TVNA procedures were reviewed. Twenty-nine of them were performed by traversing the main pulmonary artery or its branches. Three involved transvascular access through the azygous vein, 2 via the brachiocephalic artery and 1 through the superior vena cava. Only 4 patients (11.4%) experienced postprocedural complications, which included mild hemoptysis, moderate hemoptysis requiring epinephrine and saline infusion, acute exacerbation of chronic obstructive pulmonary disease, and a rapid ventricular rate on top of preexisting atrial fibrillation. The yield of TVNA for malignancy was 22 (95.6%) of 23 patients. Overall yield was 31 (88.6%) of 35, with a need for additional intervention in 4 (11.4%) of 35 patients. Mutational analysis was adequate when ordered. In our single-center experience, the EBUS-TVNA procedure had a high diagnostic yield and was associated with low rates of postprocedural complications. Further trials are needed to assess its efficacy compared to more invasive procedures.
Sections du résumé
BACKGROUND
Thoracic vascular structures often preclude transbronchial access to central lung parenchymal lesions and lymph nodes, thereby necessitating either a surgical or transvascular needle aspiration (TVNA) approach for diagnostic sampling. The aim of this study was to evaluate the safety and efficacy of endobronchial ultrasound (EBUS) TVNA in the diagnosis and staging of mediastinal tumors.
PATIENTS AND METHODS
We performed a retrospective analysis of 35 cases of EBUS-TVNA. Cases were reviewed in the Cerner electronic medical records between March 2013 and October 2018. Records were reviewed for patient comorbidities, smoking status, anticoagulation intake, procedural details, sample results, and postprocedural complications.
RESULTS
Thirty-five EBUS-TVNA procedures were reviewed. Twenty-nine of them were performed by traversing the main pulmonary artery or its branches. Three involved transvascular access through the azygous vein, 2 via the brachiocephalic artery and 1 through the superior vena cava. Only 4 patients (11.4%) experienced postprocedural complications, which included mild hemoptysis, moderate hemoptysis requiring epinephrine and saline infusion, acute exacerbation of chronic obstructive pulmonary disease, and a rapid ventricular rate on top of preexisting atrial fibrillation. The yield of TVNA for malignancy was 22 (95.6%) of 23 patients. Overall yield was 31 (88.6%) of 35, with a need for additional intervention in 4 (11.4%) of 35 patients. Mutational analysis was adequate when ordered.
CONCLUSION
In our single-center experience, the EBUS-TVNA procedure had a high diagnostic yield and was associated with low rates of postprocedural complications. Further trials are needed to assess its efficacy compared to more invasive procedures.
Identifiants
pubmed: 33526380
pii: S1525-7304(20)30330-2
doi: 10.1016/j.cllc.2020.10.020
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e595-e601Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.