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Role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) in the respiratory diseases Pulmonary Department, Shanghai Chest.

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Presentation on theme: "Role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) in the respiratory diseases Pulmonary Department, Shanghai Chest."— Presentation transcript:

1 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

2  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

3 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.

4  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.

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6  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 )

7 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

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.

9 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.

10 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

11 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.

12 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.

13 EBUS-TBNA 在 2008 年引入中国投入临床使用, 我院于 2009 年 6 月引进该项设备和技术,在完 成 5 例学习曲线训练后于 2009 年 7 月 10 日至 2010 年 2 月 24 日共行 EBUS-TBNA 检查 95 例,其中经 病理学检查和临床随访验证肺癌病人 60 例

14 临床诊断结果: 60 例肺癌患者中, 非小细胞 肺癌 50 例:低分化癌 12 例,鳞癌 16 例,腺癌 21 例;小细胞癌 8 例;低分化伴小细胞癌 3 例。 2.2 穿刺结果: 60 例病人共穿刺 112 组 LN ( 2R 组 5 例次, 4R 组 28 例次, 4 L 组 10 例次, 7 组 34 例次, 10L 组 5 例次, 10R 组 9 例次, 11L 组 4 例次 , 11R 组 12 例次, 12R 组 4 例次, 12L 组 1 例次), 肺内肿块 11 例(右上肺肿块 8 例次,右下肺肿 块 3 例次),每个部位共进行 1 - 4 次穿刺,平 均 1.98 次

15 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

16 总 结 Yasufuku 报道应用 EBUS-TBNA 对 70 个病人纵隔和肺 门 LN 进行穿刺,区分良恶性纵隔 LN 的敏感性、特异 性、准确率分别为 95.7% 、 100% 、和 97.1% [5] ; Herth 报道 502 例纵隔或肺门 LN 肿大患者,经 EBUS-TBNA 穿 刺 572 个 LN ,诊断敏感性为 94% 、特异性为 100% 、阳 性预测值为 100%, 无并发症出现 [6] ;多个研究表 EBUS-TBNA 诊断肺癌的平均敏感性是 90 %,假阴性 率是 20 % [7] 。传统 TBNA 根据 CT 定位进行盲穿,结果 变动较大,我们既往的一项回顾性研究提示传统 TBNA 诊断肺癌的敏感性为 61.11% [8] ,而本研究中 EBUS-TBNA 诊断肺癌的敏感性为 %,高于传统 TBNA

17 Represent cases

18 Thank you !


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