Bronchoscopy/ Endobronchial ultrasound

Slides:

Advertisements

Similar presentations

Diagnosis and Palliation for lung Cancer

Advertisements

Objective Comparison of direct real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), PET, CT for detection of mediastinal.

Indications for flexible Bronchoscopy

Clinical utilization of endobronchial ultrasound (EBUS) to stage lung cancer Francisco A. Almeida, MD, MS, FCCP Associate Staff Member Respiratory Institute.

Jaime Palomino, MD Pulmonary, Critical Care Medicine Tulane University.

Mediastinal staging in lung cancer Tuncay Göksel Ege Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı Clinical and radiological staging is enough.

Sleeve and wedge parenchyma-sparing bronchiaresections in low-grade neoplasms of the bronchial airway J Thorac Cardiov asc Surg 2007;134:373-7.

Advanced Bronchoscopy at PRMC an evidence based practice Yashvir Sangwan.

Lung cancer staging in 2011: use of pet Scan and other modalities

Matthew Kilmurry, M.D. St. Mary’s General Hospital Grand River Hospital.

EBUS-TBNA reduces the number of mediastinoscopies for the staging of lung cancer with more than fifty percent Background Methods Results Conclusion Niels.

Management of Solitary Pulmonary Nodule Marvin D. Peyton, M.D. Thoracic and Cardiovascular Surgery University of Oklahoma Health Sciences Center.

Benign and Malignant Lesions in Respiratory Cytology

AJCC Staging Moments AJCC TNM Staging 7th Edition Lung Case #1 Contributors: Valerie W. Rusch, MD Memorial Sloan-Kettering Cancer Center, New York, New.

Who Should be Responsible for the Initial Diagnosis and Staging of Lung Cancer? Surgeons vs. Non-Surgeons: Competition or Collaboration Moishe Liberman.

SURGERY FOR NSCLC GREG CHRISTODOULIDES MD, FACS, FCCP, FESTS

Chapter 28 Lung Cancer. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Objectives  Describe the epidemiology of.

Lung Cancer in 2011 Dr. Natasha Leighl, MD MMSc FRCPC Medical Oncologist, Princess Margaret Hospital Assistant Professor, Medicine, University of Toronto.

BAGHAI THORACIC SURGEON FIROOZGAR HOSPITAL THORACIC SURGERY.

WORK UP & MANAGEMENT OF SOLITARY PULMONARY NODULE Seifu B Oct-04, 2007.

Part 3B: Endobronchial Brushing volume 1

Content Approach  Anatomy & Physiology Review  Demographics/occurrence  Pathophysiology  Clinical Picture  Medical Management  Nursing Process (APIE)

SMC TS MANAGEMENT OF CILM Management of Centrally Located Indeterminate Lung Mass.

TBLB in DX of peripheral and diffuse lung cancer

Bronchoscopy and Endobronchial Ultrasound Dr. Brent Toney Pulmonary/Critical Care St. Vincent Hospital, Indianapolis.

IMAGING FINDINGS - The NSCLC stage classification is based on the TNM system: - T: extent of the primary tumor - N: extent of regional lymph node involvement.

Felix J. F. Herth, Mark Krasnik, Nicolas Kahn, Ralf Eberhardt and Armin Ernst Chest 2010;138; ; Prepublished online February 12, 2010; DOI /chest

Bronchoscopy 1 Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health –

Malignant Pleural Effusion

Electromagnetic Navigation Diagnostic Bronchoscopy Am J Respir Crit Care Med Vol 174. pp 982–989, 2006 R4 Byunghyuk Yang.

Endobronchial Ultrasound

Sensitivity and Diagnostic Accuracy of Different Sampling Modalities with Electromagnetic Navigational Bronchoscopy & Effect of Radial EBUS on Yield Deepankar.

Volume 131, Issue 1, Pages (January 2007)

Volume 125, Issue 2, Pages (February 2004)

Fundamentals of Bronchoscopy: ENDOBRONCHIAL BIOPSY

Fundamentals of Bronchoscopy: BRONCHIAL BRUSHING

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Diagnosing Intrathoracic Tuberculosis Jiayuan Sun, MD, PhD, Jiajun Teng, MD, Huizhen.

Hiren J. Mehta, MD, Tan-Lucien Mohammed, MD, Michael A. Jantz, MD

Endoscopic and Endobronchial Ultrasonography According to the Proposed Lymph Node Map Definition in the Seventh Edition of the Tumor, Node, Metastasis.

Computed Tomography Characteristics Predictive for Radial EBUS-Miniprobe-Guided Diagnosis of Pulmonary Lesions Canan Guvenc, Msc, Jonas Yserbyt, MD,

Endobronchial ultrasonography (EBUS)—Its role in staging of non–small cell lung cancer and who should do it? Rafael S. Andrade, MD, David D. Odell, MD,

Hidenao Kayawake, MD, Toyofumi F

A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph.

Virtual endobronchial ultrasound for transbronchial needle aspiration

Foamy Macrophage Deposition in Lymph Nodes Mimicking Lung Cancer Recurrence Diagnosed via Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration.

Video-Assisted Mediastinoscopic Lymphadenectomy for Staging Non-Small Cell Lung Cancer Sergi Call, MD, Carme Obiols, MD, PhD, Ramon Rami-Porta, MD, PhD,

Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound- guided transbronchial needle aspiration: Are two better than one in mediastinal.

Successful tissue collection in patients with relapse of EGFR-positive adenocarcinoma after EGFR-TKI treatment. Successful tissue collection in patients.

The Changing Face of Outpatient Bronchoscopy in 2013

Endobronchial Ultrasound

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Evaluation of Suspected Lymphoma Daniel P. Steinfort, MBBS, FRACP, Matthew Conron,

The Nuances of Staging Lung cancer Gerard A

Endobronchial Ultrasonography: Current Status and Future Directions

Diagnosis of Mediastinal Adenopathy—Real-Time Endobronchial Ultrasound Guided Needle Aspiration versus Mediastinoscopy Armin Ernst, MD, FCCP, Devanand.

Utility of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Mediastinal Masses of Unknown Etiology Kazuhiro Yasufuku,

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Lymph Node Staging in Patients with Non-small Cell Lung Cancer in Nonoperable Patients.

Cost-Benefit of Minimally Invasive Staging of Non-small Cell Lung Cancer: A Decision Tree Sensitivity Analysis Daniel P. Steinfort, MBBS, FRACP, Danny.

The Yield of Endoscopic Ultrasound in Lung Cancer Staging: Does Lymph Node Size Matter? Kurt G. Tournoy, MD, Frédéric De Ryck, MD, Lieve Vanwalleghem,

Fundamentals of Flexible Bronchoscopy Conventional Transbronchial Needle Aspiration RESULTS AND COMPLICATIONS

Establishing the Diagnosis of Lung Cancer

Endobronchial Ultrasound versus Mediastinoscopy for Mediastinal Nodal Staging of Non–Small-Cell Lung Cancer Sang-Won Um, MD, PhD, Hong Kwan Kim, MD,

Diagrammatic representation of diagnostic performance characteristics of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in.

Pyng Lee, MD, Henri G. Colt, MD, FCCP Journal of Thoracic Oncology

Distribution and Likelihood of Lymph Node Metastasis Based on the Lobar Location of Nonsmall-Cell Lung Cancer Robert J. Cerfolio, MD, Ayesha S. Bryant,

Pulmonary nodules discovered on CT scan of the chest

Can FDG-PET reduce the need for mediastinoscopy in potentially resectable nonsmall cell lung cancer? Kemp H Kernstine, MD, PhD, Kelley A McLaughlin,

Evaluation of fluorine-18-fluorodeoxyglucose whole body positron emission tomography imaging in the staging of lung cancer Catherine A.B Saunders, Julian.

David Feller-Kopman, MD, William Lunn, MD, Armin Ernst, MD

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Intrapulmonary Lesions Takahiro Nakajima, MD, Kazuhiro Yasufuku,

Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography Michael B Wallace, MD, James Ravenel, MD, Mark I Block,

Presentation transcript:

Bronchoscopy/ Endobronchial ultrasound Chi Young Jung, MD, PhD Associate professor Division of Pulmonary & Critical Care Medicine Daegu Catholic University Medical Center

Contents Bronchoscopy - diagnosis of primary tumor - staging Endobronchial ultrasound (EBUS) - EBUS-TBNA - radial probe EBUS guided TBLB

Bronchoscopy

bronchoscopy

Types of bronchoscopy Flexible bronchoscopy Rigid bronchoscopy virtual bronchoscopy

Anatomy of tracheobronchial tree

Flexible bronchoscopy Traditional white light bronchoscopy Endobronchial ultrasound (EBUS) Navigation bronchoscopy (NB) Ultrathin bronchoscopy Confocal bronchoscopy Fluorescence bronchoscopy

White light bronchoscopy

Endobronchial biopsy

Bronchial washings

Bronchial brushings

Transbronchial lung biopsy: TBLB

Transbronchial needle aspiration: TBNA

Staging Bronchoscopy is routinely performed pre-operatively : assess for synchronous lesions : delineate tumor margins Blind bronchoscopic TBNA can access lymph nodes : subcarinal (7), paratracheal (4), hilar (10)

Anatomy of tracheobronchial tree 2cm

Complication Bleeding Pneumothorax: TBLB Mild transient hypotension related to sedation Bronchospasm, hypoxemia Infection Epistaxis Cardiac arrhythmia

Endobronchial ultrasound: EBUS

Endobronchial ultrasound (EBUS)

EBUS vs EUS EBUS EUS

Types of EBUS Convex probe EBUS Radial probe EBUS

EBUS-TBNA: Indications Diagnosis & staging of lung cancer Mediastinal lymphadenopathy of unclear etiology Sampling parenchymal pulmonary nodules, endobronchial or peribronchial lesions Sampling mediastinal masses

Schematic of EBUS-TBNA

EBUS-TBNA

EBUS-TBNA

EBUS-TBNA

Advantages Minimally-invasive, safe procedure Outpatient basis Local anesthesia & conscious sedation Access a wide range of mediastinal LN & hilar LN Sample centrally located pulmonary lesions

Approaches to LNs in mediastinum

Bronchus and mediastinal structures

Diagnostic algorithm Lung mass with suspected NSCLC Imaging: CT with contrast, PET-CT Distant metastasis? No Yes Evidence of N1, N2, or N3 by CT or PET Biopsy most accessible lesion Yes No EBUS-TBNA or mediastinoscopy Large tumor with high pretest probability of nodal involvement (T1b or larger) Yes Consider EBUS-TBNA or mediastinoscopy

M/71 Cough

Chest CT scan

EBUS-TBNA adenocarcinoma

EBUS-TBNA: meta-analysis (11 studies, 1,299 patiens) 93% 100% Eur J Cancer 2009;45:1389-96.

EBUS-TBNA: meta-analysis (10 studies, 817 patiens) sensitivity specificity 88% 100% Thorax 2009;64:757-62.

EBUS-TBNA vs Mediastinoscopy Lymph Node Size in mm: Mean ± SD (Range) EBUS Yield (%) Mediastinoscopy Yield p All lymph nodes 15 ± 2.6 (10–21) 109/120 (91) 94/120 (78) 0.007 Lymph node station 2 all 16 ± 3.1 (10–21) 24/25 (96) 22/25 (88) 0.30 2 right 18 ± 1.6 (14–20) 12/13 (92) 11/13 (85) 0.99 2 left 14 ± 3.6 (10–21) 12/12 (100) 11/12 (92) 4 all 15 ± 2.6 (10–19) 45/54 (83) 40/54 (74) 0.24 4 right 29/34 (85) 24/34 (71) 0.14 4 left 16/20 (80) 7 15 ± 2.4 (10–19) 40/41 (98) 32/41 (78) Pathology Malignant 16 ± 2.7 (10–21) 64/74 (86) 49/74 (66) 0.004 Benign 15 ± 2.5 (10–21) 45/46 (98) (66 patients, 120 LNs) J Thorac Oncol 2008;3:577-82.

EBUS-TBNA/EUS-FNA vs Mediastinoscopy 79 94 Mediastinoscopy EBUS-TBNA/EUS-FNA alone Sensitivity 79% 85% JAMA 2010;304:2245-52.

EBUS-TBNA/EUS-FNA: meta-analysis (8 studies, 821 patiens) Sensitivity : 86% Specificity : 100%

Combined EBUS-TBNA & EUS-FNA Combined vs EBUS-TBNA Combined vs EUS-FNA Eur Respir J 2015;46:40-60.

Accuracy for staging of mediastium Methods Sensitivity Specificity PPV NPV CT 55 81 58 83 PET 80 88 75 91 PET-CT 62 90 63 Mediastinoscopy 81(94*) 100 91(98*) VATS 99 96 TBNA 78 77 EBUS-TBNA 89 86 EBUS-TBNA, real-time EBUS-TBNA & EUS-FNA, real-time * Mediastinal lymphadenectomy & videomediastinoscopy Chest 2013;143:e211s-50s.

Complication Hypoxemia, cough, agitation during the procedure Atrial fibrillation Bronchial edema/ hyperemia Minute bleeding Stridor Pneumothorax Hematoma Asymptomatic pneumo-mediastinum Infection: mediastinitis Puncture of the bronchoscope

Radial probe EBUS

Transbronchial lung biopsy (TBLB)

in normal aereated lung Within Radial probe EBUS Adjacent to ‘Snowstorm’ picture in normal aereated lung

Radial probe EBUS

Radial probe EBUS

F/73 pneumonia

Chest CT scan

Radial probe EBUS guided TBLB & cytology Radial probe EBUS guided adenocarcinoma

Summary EBUS-TBNA have been shown to have a good diagnostic accuracy in the diagnosis and staging of lung cancer EUBS-TBNA is technically feasible and safe procedure Combination of EBUS-TNBA & EUS-FNA is preferred over either test alone Radial probe EBUS-guided TBLB can be used for diagnosis of peripheral lung cancer