The Value Of Convex Probe Endobronchial Ultrasound-guided Transbronchial Needle Aspiration(EBUS-TBNA) In Hilar, Mediastinal And Intrapulmonary Lesions

Objective To evaluate the diagnostic value of real-time convex-probe endobronchial ultrasound(EBUS)-guided transbronchial needle aspiration(TBNA) in hilar, mediastinal and intrapulmonary lesions.Methods Retrospective clinical trial of 119 consecutive patients with enhanced lymph node or mass in the mediastinum and adjacent to the trachea or bronchial, with or without pulmomary lesions, nondiagnosis by routine electronic bronchoscope were included in this study, conducted between May 2012 and Mar 2014. Samples were obtained from the lesions using the TBNA method, with the guidance of CP-EBUS. The rapid on-site cytologic evaluation(ROSE), histopathologic and microbiologic were employed. For patients who could not be diagnosed with EBUS-TBNA, invasive operation or more than 6 months of clinical and imaging follow- up was carried out. The numbers of final diagnosis and the features of ultrasonic were recorded, and analysed by SPSS software.Results Two hundred and thirty- four mediastinal lymph nodes and twenty-six masses adjacent to the trachea or bronchial were sampled by EBUS-TBNA in 119 patients. The final diagnosis by EBUS-TBNA were 33 adenocarcinoma, 7 squamous cell carcinoma, 1 salivaryglandneoplasms, 16 small lung cancer, 1 poorly differentiated carcinoma, 1 mediastinal lymph node metastasis of esophageal cancer, 1 mediastinal lymph node metastasis of colon cancer, 31 tuberculosis lymphadenitis, 8 inflammation, 7 sarcoidosis, and 3 mediastinal cysts. O f ten cases who could not acquire diagnosis by EBUS-TBNA, five cases acquired the invasive procedures mediastinoscopy and 3 cases confirmed as sarcoidosis, 1 cases was tuberculosis, and 1cases was nonspecific inflammation. In other five patients, one case acquired thoracotomy to be confirmed as Castleman disease, and the other four cases were followed up at least 6 months, of those, 2 cases was confirmed tuberculosis lymphadenitis, and the others have no obvious image changes. The diagnosis yeild of EB U S- TB N A for hilar, mediastinal and intrapulmonary lesions w ere 91.6%, and EBUS-TBNA has satisfactory diagnostic value for benign and malignant of hilar, mediastinal and intrapulmonary lesions. Minor co mp licatio ns were fo und in 15 cases, two patients experienced transient hypoxemia, six patients had a few blood-stained sputum, four cases had pharynx pain, two patients had low-grade fever, and one needle tractdisseminated by mediastinal tuberculosis lymphadenitis.Conclusion EBUS-TBNA was a minimally invasive, safety and effective diagnosis technique for hilar, mediastinal and intrapulmonary lesions. The diagnosis rates in maligancies and benignancies were satisfactory.