1. Role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) in the respiratory diseases Pulmonary Department, Shanghai Chest Hospital Respiratory Endoscopy Clinic Base,The Ministry of Health Han Baohui

2.  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 Background

3. The role of EBUS- TBNA in the diagnosis and staging of lung cancer Fig. A :EBUS –TBNA conceptual diagram B needle A  Realtime EBUS-guided TBNA was developed in 2002. Fig.B: a realtime puncture was performed under EBUS C Fig.C: EBUS-TBNA obtained histological specimens.

4.  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.

6.  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 )

7. 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%. EBUS-TBNA was un - eventful, and there were no complications. Yasufuku K, Nakajima T, Motoori K, et al. Chest 2006;130(3):710–8

8. Comparison of EBUS-TBNA and invasive methods 2 Toloza EM, Harpole L, Detterbeck F, et al. Chest 2003; 123 (1 Suppl):157S–166S. 3 Detterbeck FC, Jantz MA, Wallace M, et al. Chest 2007; 132 (3 Suppl):202S–220S. 4 Cybulsky IJ, Bennett WF. Ann Thorac Surg 1994; 58:176–178.

9. 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.

10. EBUS-TBNA-systematic review and meta － analysis Gu P, Zhao YZ, Han BH (Corresponder),et al. European Journal of Cancer,2009;45(8):1389-96.  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

11. 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.

12. 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.

13. EBUS-TBNA 在 2008 年引入中国投入临床使用， 我院于 2009 年 6 月引进该项设备和技术，在完 成 5 例学习曲线训练后于 2009 年 7 月 10 日至 2010 年 2 月 24 日共行 EBUS-TBNA 检查 95 例，其中经 病理学检查和临床随访验证肺癌病人 60 例

14. 临床诊断结果： 60 例肺癌患者中， 非小细胞 肺癌 50 例：低分化癌 12 例，鳞癌 16 例，腺癌 21 例；小细胞癌 8 例；低分化伴小细胞癌 3 例。 2.2 穿刺结果： 60 例病人共穿刺 112 组 LN （ 2R 组 5 例次， 4R 组 28 例次， 4 L 组 10 例次， 7 组 34 例次， 10L 组 5 例次， 10R 组 9 例次, 11L 组 4 例次 ， 11R 组 12 例次， 12R 组 4 例次, 12L 组 1 例次）， 肺内肿块 11 例（右上肺肿块 8 例次，右下肺肿 块 3 例次），每个部位共进行 1 － 4 次穿刺，平 均 1.98 次

15. 60 个实时 EBUS-TBNA 病人穿刺纵隔 / 肺门 LN 和肺内肿块的位置和结果 Table 1 Results of real-time EBUS-TBNA in 60 patients with mediastinal/hilar lymph nodes and intrapulmonary mass by location. LN station /intrapulmonary mass Nodes/masses(n) Cell smears positive (n) Tissue specimens positive (n) Total positive (n) Nodes /masse s diagn osed (%) 2R5545100.00 4R2823182382.14 4L1078880.00 73427142882.35 10L542480.00 10R975777.78 11L433375.00 11R1276758.33 12R422375.00 12L1111100.00 right upper lobe8758100.00 right lower lobe311266.67 Total12394699980.49 60 个实时 EBUS-TBNA 病人穿刺纵隔 / 肺门 LN 和肺内肿块的位置和结果

16. 总 结 Yasufuku 报道应用 EBUS-TBNA 对 70 个病人纵隔和肺 门 LN 进行穿刺，区分良恶性纵隔 LN 的敏感性、特异 性、准确率分别为 95.7% 、 100% 、和 97.1% [5] ； Herth 报道 502 例纵隔或肺门 LN 肿大患者，经 EBUS-TBNA 穿 刺 572 个 LN ，诊断敏感性为 94% 、特异性为 100% 、阳 性预测值为 100%, 无并发症出现 [6] ；多个研究表 EBUS-TBNA 诊断肺癌的平均敏感性是 90 ％，假阴性 率是 20 ％ [7] 。传统 TBNA 根据 CT 定位进行盲穿，结果 变动较大，我们既往的一项回顾性研究提示传统 TBNA 诊断肺癌的敏感性为 61.11% [8] ，而本研究中 EBUS-TBNA 诊断肺癌的敏感性为 96.67 ％，高于传统 TBNA

17. Represent cases

18. Thank you ！