Presentation on theme: "Role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) in the respiratory diseases Pulmonary Department, Shanghai Chest."— Presentation transcript:
Role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) in the respiratory diseases Pulmonary Department, Shanghai Chest Hospital Respiratory Endoscopy Clinic Base,The Ministry of Health Han Baohui
Lung cancer has replaced liver cancer to become the first cause of death in China Accurate staging of the disease is important not only to determine the prognosis but also to decide the most suitable treatment plan During the staging process, mediastinal lymph node staging is one of the most important factors that affect the patient outcome Background
The role of EBUS- TBNA in the diagnosis and staging of lung cancer Fig. A :EBUS –TBNA conceptual diagram B needle A Realtime EBUS-guided TBNA was developed in Fig.B: a realtime puncture was performed under EBUS C Fig.C: EBUS-TBNA obtained histological specimens.
EBUS-TBNA indications : lymph node staging in lung cancer patients; diagnosis of intrapulmonary tumors; diagnosis of unknown hilar and/or mediastinal lymphadenopathy; diagnosis of mediastinal tumors.
The pooled sensitivity of real-time EBUS － TBNA in lung cancer is 90%, but the false negative rate is 20%;The sensitivity of conventional TBNA was only 65% in our experience More than 60 cases were examined by EBUS-TBNA since June 11, 2009 in our hospital,the sensitivity in the diagnosis of lung cancer was above 90% after finishing learning curve Sun Jiayuan, Wang Jianhua, Han Baohui （ corresponder ） et al. Significance of transbronchial needle aspiration (TBNA) in the diagnosis of bronchogenic carcinoma.Journal of Shanghai Jiaotong university （ medical science ） 2008,28(12):1597 － Sun Jiayuan, Zhaoheng, Han Baohui （ corresponder ） et al. Clinical analyses of initial 30 cases examined by endobronchial ultrasound-guided transbronchial needle aspiration: a single institution's early learning curve (to be published )
Comparison of EBUS-TBNA and noninvasive methods The sensitivities of CT, PET, and EBUS-TBNA for the correct diagnosis of mediastinal and hilar lymph node staging were 76.9%, 80.0%, and 92.3%, respectively; Specificities were 55.3 %, 70.1%, and 100%, and diagnostic accuracies were 60.8%, 72.5%, and 98.0%. EBUS-TBNA was un - eventful, and there were no complications. Yasufuku K, Nakajima T, Motoori K, et al. Chest 2006;130(3):710–8
Comparison of EBUS-TBNA and invasive methods 2 Toloza EM, Harpole L, Detterbeck F, et al. Chest 2003; 123 (1 Suppl):157S–166S. 3 Detterbeck FC, Jantz MA, Wallace M, et al. Chest 2007; 132 (3 Suppl):202S–220S. 4 Cybulsky IJ, Bennett WF. Ann Thorac Surg 1994; 58:176–178.
Comparison of EBUS-TBNA and mediastinoscopy Current conclusion :When the prevalence of N2 or N3 disease was high, existing data favour EBUS but when it is moderate then cervical mediastinoscopy appears superior.
EBUS-TBNA-systematic review and meta － analysis Gu P, Zhao YZ, Han BH (Corresponder),et al. European Journal of Cancer,2009;45(8): EBUS-TBNA for LN staging. 11 studies (n=1299) Sensitivity =0.93 (95% CI, ),Specificity =100 (95% CI, ) Study sensitivity not related to prevalence of LN metastasis
Future directions 1. Evaluating the whole mediastinum LN by combining EBUS-TBNA and EUS-FNA 2.Comparing the gold standard mediastinoscopy and EBUS-TBNA forlymph node staging. 3. EBUS-TBNA restaging of the mediastinum after the introduction of chemotherapy. 4. EBUS-TBNA samples will possibly provide molecular biological information that will be useful for the treatment of lung cancer.
Other applications Lymphoma ： the reported diagnostic sensitivity is 91% ； Sarcoidosis ： the demonstration of non-caseating granulomatous inflammation range from 85 － 94% ； Paratracheal and peri-bronchial tumors ： with a diagnostic sensitivity of 82 － 94% ； Drain mediastinal and bronchogenic cysts and consequently relieve central airway obstruction; Tuberculosis: could diagnose the tuberculous mediastinal lymphadenitis and intrapulmonary mass in our experience.
60 个实时 EBUS-TBNA 病人穿刺纵隔 / 肺门 LN 和肺内肿块的位置和结果 Table 1 Results of real-time EBUS-TBNA in 60 patients with mediastinal/hilar lymph nodes and intrapulmonary mass by location. LN station /intrapulmonary mass Nodes/masses(n) Cell smears positive (n) Tissue specimens positive (n) Total positive (n) Nodes /masse s diagn osed (%) 2R R L L R L R R L right upper lobe right lower lobe Total 个实时 EBUS-TBNA 病人穿刺纵隔 / 肺门 LN 和肺内肿块的位置和结果