Role of endobronchial ultrasound-guided

transbronchial needle aspiration (EBUSTBNA) in the respiratory diseases

Pulmonary Department, Shanghai Chest Hospital
Respiratory Endoscopy Clinic Base ,The Ministry of Health
Han Baohui

Background
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

The role of EBUS- TBNA in the diagnosis

and staging of lung cancer
Realtime EBUS-guided TBNA was developed in 2002.

needle

Fig.B: a realtime puncture was Fig.C: EBUS-TBNA obtained

Fig. A :EBUS TBNA
performed under EBUS
conceptual diagram
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 1599.

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%.

Yasufuku K, Nakajima T, Motoori K, et al. Chest 2006;130(3):7108

EBUS-TBNA was un
-eventful, and there were
no complications.

Comparison of EBUS-TBNA and

invasive methods

2 Toloza EM, Harpole L, Detterbeck F, et al. Chest 2003; 123 (1 Suppl):157S166S.

3 Detterbeck FC, Jantz MA, Wallace M, et al. Chest 2007; 132 (3 Suppl):202S220S.
4 Cybulsky IJ, Bennett WF. Ann Thorac Surg 1994; 58:176178.

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
EBUS-TBNA for LN staging. 11 studies (n=1299)
Sensitivity =0.93 (95% CI, 0.91-0.94),Specificity =100 (95% CI , 0.99-1.00)
Study sensitivity not related to prevalence of LN metastasis

Gu P, Zhao YZ, Han BH (Corresponder),et al. European Journal of Cancer,2009;45(8):1389-96.

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.

 EBUS-TBNA 2008
2009 6
5 2009 7
10 2010 2 24 EBUS-TBNA
95
60

 60
50 12 16
21 8 3

2.2 60 112
LN 2R 5 4R 28 4 L 10
7 34 10L 5 10R 9
, 11L 4 11R 12 12R 4
, 12L 1 11
8 3
1 4 1.98

60 EBUS-TBNA /
LN
Nodes/masses(n)

Cell smears
positive
(n)

Tissue specimens
positive
(n)

Total positive
(n)

Nodes
/masse
s
diagn
osed
(%)

2R

100.00

4R

28

23

18

23

82.14

4L

10

80.00

34

27

14

28

82.35

10L

80.00

10R

77.78

11L

75.00

11R

12

58.33

12R

75.00

12L

100.00

right upper lobe

100.00

right lower lobe

66.67

Total

123

94

69

99

80.49

LN station
/intrapulmonary mass


Yasufuku EBUS-TBNA 70
LN LN
95.7% 100%
97.1% [5] Herth 502 LN
EBUS-TBNA 572 LN
94% 100% 100%,
[6] EBUS-TBNA
90 20 [7]
TBNA CT
TBNA
61.11% [8] EBUS-TBNA
96.67 TBNA

 Represent cases

Thank
you