Ebus-tbna In The Diagnosis Of Mediastinal Lesions - Cases In A Single Center In The City Of Sao Paulo - Brazil
Ricardo S. Santos1, Marcia Jacomelli1, Juliana P. Franceschini2, Iunis Suzuki1, Altair Costa, Jr1, Christina Shiang1, Addy LM Palomino1.
1Hospital Israelita Albert Einstein, São Paulo, Brazil, 2Instituto Tórax, São Paulo, Brazil.
OBJECTIVE: Mediastinal lesions are commonly assessed by imaging methods, especially computed tomography (CT). Symptoms do not always define the specific diagnosis of the lesion. So on suspicion of active mediastinal disease related to cancer or infectious/inflammatory disease biopsy is required. Surgery and mediastinoscopy are established methods of approaching the mediastinum. Conventional transbronchial needle aspiration (C-TBNA) is a recognized method for collecting tissue and cell samples through flexible bronchoscopy, but does not allow real-time lymph node vision. The endobronchial ultrasound associated with needle aspiration (EBUS-TBNA) comes preferentially to collect lymph nodes, peribronchial or peritracheal masses. The technique was recently introduced in Brazil and very little has been published about its results. To describe the results of the application of EBUS-TBNA in the definition of diagnosis in cases of mediastinal lesions due to different causes in a private institution in the city of São Paulo.
METHODS: A retrospective cross-sectional study of EBUS-biopsied patients. We included all cases referred for collection of lymph nodes or peritracheal and/or peribronchial masses by EBUS-TBNA, between June 2013 and October 2016, studied with CT or PET-CT. All cases were performed by interventional pulmonologists and thoracic surgeons with experience in the procedure. Rapid on-site evaluation (ROSE) of fine needle aspiration (FNA) biopsy was performed in all cases by an experienced pathologist, and the materials were prepared on slides and sent for histopathological analysis and other conditions according to a need.
RESULTS: 72 patients were accessed. Of these, 6 were excluded for identifying endobronchial lesions that could be biopsied or intrathoracic lesions not accessible by EBUS. Thus, a total of 66 patients were included in the analysis. The mean age was 61.17 (± 14.67) years old and the male gender predominated (42-64%). EBUS-TBNA was definitive for diagnosis in 60 cases (91%), 3 (4.5%) were inconclusive and in only 1 (1.5%) the result was false negative. In 2 (3%) cases there was loss of follow-up. There were no complications during or after the procedure.
CONCLUSIONS: In our series, EBUS-TBNA had a high diagnostic yield, with minimal morbidity, constituting an excellent option for patients with lymphadenopathy or intrathoracic expansive lesions.
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