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. 2019 Jan-Mar;36(1):65-70.
doi: 10.4103/JOC.JOC_171_18.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Techniques and Challenges

Valliappan Muthu  1 , Inderpaul Singh Sehgal  1 , Sahajal Dhooria  1 , Kuruswamy T Prasad  1 , Nalini Gupta  2 , Ashutosh N Aggarwal  1 , Ritesh Agarwal  1
Affiliations

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Techniques and Challenges

Valliappan Muthu et al. J Cytol. 2019 Jan-Mar.

Abstract

Intrathoracic lymphadenopathy is a common problem encountered in clinical practice and is caused by a wide variety of diseases. Traditionally, the mediastinal lymph nodes were sampled using conventional transbronchial needle aspiration (TBNA), or surgical methods such as mediastinoscopy, and thoracotomy (open or video-assisted thoracoscopy). However, surgical modalities including mediastinoscopy are invasive, expensive, and not universally available. Moreover, they are associated with considerable morbidity and mortality. Conventional TBNA although minimally invasive has a low diagnostic yield. In the last decade, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as the diagnostic procedure of choice in evaluating undiagnosed intrathoracic lymphadenopathy. EBUS-TBNA is also currently the preferred modality in the mediastinal staging of lung cancer. The procedure is minimally invasive, safe, and can be performed as a day-care procedure. In the era of personalized medicine in lung cancer, optimizing the procedure, sample collection, and processing are crucial, as more tissue is required for performing a wide array of molecular tests. Despite its widespread use and acceptance, the diagnostic sensitivity of EBUS-TBNA is still low. To maximize the yield, cytologists and physicians should be aware of the technical details of the procedure. Herein, we discuss the technique of performing EBUS-TBNA, its indications, contraindications, and the processing of the samples at our bronchoscopy suite. We also highlight the challenges faced by the cytologists and clinicians while processing EBUS aspirates.

Keywords: Bronchoscopy; ROSE; cytology; endoscopic ultrasound; sarcoidosis; tuberculosis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The endobronchial ultrasound bronchoscope is a flexible bronchoscope with a convex ultrasound transducer at its tip (Panel A). The ultrasound probe can be enclosed within a balloon that can be inflated with normal saline during the procedure (Panel B). The needle can be passed through the working channel of the echobronchoscope and exits at an angle of 30° (Panel C)
See this image and copyright information in PMC

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