Case Report
Diagnosis of Non-nodal Paratracheobronchial Lesions by Linear Endobronchial Ultrasound
Diagnóstico de lesiones paratraqueobronquiales no adenopáticas mediante ecobroncoscopia lineal
Tamara Lourido, Maribel Botana, Virginia Leiro, Manuel Núñez, Alberto Fernández-Villar
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Servicio de Neumología, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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C y D: Imágenes de TC y ecoendoscópica de un paciente con una lesión pulmonar en lóbulo inferior izquierdo y una adenopatía en la estación mediastínica 9 derecha, puncionadas ambas por ecobroncoscopia a través del esófago con resultado en las 2 de metástasis de carcinoma de colon. E y F: Imágenes de TC y ecoendoscópica de una masa hiliar izquierda que engloba la arteria pulmonar con punción guiada por ecobroncoscopia diagnóstica de adenocarcinoma de origen pulmonar. G y H: Imágenes de TC y ecoendoscópica de una masa paratraqueoesofágica derecha de posible origen en el lóbulo superior derecho con diagnóstico tras punción realizada a través del esófago de adenocarcinoma de origen pulmonar. <span class="elsevierStyleSmallCaps">I</span> y J: Imágenes de TC y ecoendoscópica de una masa localizada en el lóbulo superior derecho que infiltraba mediastino puncionada por ecobroncoscopia, con resultado de adenocarcinoma de origen pulmonar.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tamara Lourido, Maribel Botana, Virginia Leiro, Manuel Núñez, Alberto Fernández-Villar" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Tamara" "apellidos" => "Lourido" ] 1 => array:2 [ "nombre" => "Maribel" "apellidos" => "Botana" ] 2 => array:2 [ "nombre" => "Virginia" "apellidos" => "Leiro" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Núñez" ] 4 => array:2 [ "nombre" => "Alberto" "apellidos" => "Fernández-Villar" ] ] ] ] ] "idiomaDefecto" => 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(A and B) Computed tomography (CT) and endoscopic ultrasound images of a mass located in the right upper lobe, aspirated using endobronchial ultrasound, the result of which was adenocarcinoma of pulmonary origin. (C and D) CT and endoscopic ultrasound images of a patient with a pulmonary lesion in the left lower lobe and lymphadenopathy in right mediastinal station 9. Both were aspirated using endobronchial ultrasound via the oesophagus; the result in both was colon cancer metastasis. (E and F) CT and endoscopic ultrasound images of a left hilar mass surrounding the pulmonary artery, with EBUS-guided needle aspiration diagnostic of adenocarcinoma of pulmonary origin. (G and H) CT and endoscopic ultrasound images of a right paratracheoesophageal mass possibly originating in the right upper lobe, with needle aspiration carried out via the oesophagus, resulting in a diagnosis of adenocarcinoma of pulmonary origin. (I and J) CT and endoscopic ultrasound images of a mass located in the right upper lobe infiltrating the mediastinum. EBUS-guided fine needle aspiration was performed with a result of adenocarcinoma of pulmonary origin.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Linear endobronchial ultrasound (EBUS) allows the non-invasive and safe sampling of any type of lesion close to the airways and digestive tract, as it enables needle aspiration to be performed under visual control in real time (EBUS-TBNA).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most widely-accepted indications for EBUS-TBNA are the diagnosis, staging and restaging of lung carcinoma from mediastinal lymph node samples, although its application in the study of other diseases such as lymphomas, and granulomatous diseases like sarcoidosis and tuberculosis, has also been described.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, little evidence is available on the usefulness and safety of EBUS-TBNA in the diagnosis of other types of lung and mediastinal lesions adjacent to the airways or oesophagus.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation (Case Series)</span><p id="par0010" class="elsevierStylePara elsevierViewall">Forty-three (43) lesions of possible non-nodal origin were selected from a database of 730 different lesions aspirated by EBUS-TBNA in 450 patients. After a comprehensive review of the imaging studies and cytopathological findings, 26 cases in which the authors were completely sure that the aspirated lesion was non-nodal were included in this analysis. The other 17 lesions were hilar or paratracheal masses from which, although suitable material was obtained for the diagnosis of malignancy in all cases, with no histological data to suggest that a lymph gland had been aspirated, there was some possibility, due their location, that they could have initially originated from metastatic hilar or paratracheal lymph node involvement.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The procedures were performed by four bronchoscopists in an outpatient setting, with conscious sedation with midozalam and fentanyl. The samples were examined immediately by a pathologist. An Olympus UC180F endobronchial ultrasound scope and an Aloka Alpha 5 ultrasound system were used. All patients signed an informed consent form.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The mean age of the 26 patients was 62 (SD, 12) years and 18 (69%) were male. None had endobronchial lesions. In 8 (30.8%) of the cases, the lesion was exclusively intrapulmonary, in 16 (65.4%) the lesions were pulmonary with mediastinal contact or infiltration and another 2 (7.6%) cases were paraesophageal lesions. All were less than 10<span class="elsevierStyleHsp" style=""></span>mm from the airways or oesophagus; the mean diameter was 31 (SD, 16) mm, the most common location was the right upper lobe (61.5%), the mean SUV on PET-CT was 11.9 (SD, 4.2) and 2 (SD, 0.9) passes were made each time. In 3 cases, access was via the oesophagus and samples were obtained satisfactorily in all 3 cases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Suitable material was obtained from 25 (96.1%) lesions. Of these, 16 (61.5%) were pulmonary adenocarcinomas and 6 (23.7%) other subtypes, 2 (7.6%) were extrapulmonary carcinomas, 1 (3.8%) a tubercular lesion and 1 (3.8%) a pneumonic process. In the case of one patient with pulmonary adenocarcinoma, insufficient material was obtained for a specific diagnosis and it was confirmed by surgery.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows some examples of the computed tomography (CT) and endoscopic ultrasound images obtained.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">No complications related with the procedures were described.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis of paramediastinal or central pulmonary lesions with no endobronchial lesion is a clinical problem, since conventional diagnostic techniques are not very effective for obtaining a cytohistological diagnosis, and the results depend in large part on the size of the lesions, presence or absence of the bronchus sign and the availability of new technologies.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> For lesions closer to the central airways or the digestive tract, one possible option is the use of EBUS, a technique that has been widely validated in the study of mediastinal lymphadenopathies, although there is little published evidence in these types of lesions and few series address this indication exclusively.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,5</span></a> In the study by Tournoy et al.,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> all the lesions were intrapulmonary and of malignant aetiology, while in the report published by Yang et al.,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> as in ours, lesions adjacent to the airways, whether intrapulmonary or mediastinal, and of benign aetiology (such as tuberculosis and mediastinal cysts) were also included. We found only one series published in Spain in the form of an abstract.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The review of these cases confirms the value and safety of EBUS-TBNA in both the respiratory tract and the oesophagus in the diagnosis of non-endobronchial central lesions of different aetiologies. One possible limitation of this study is that we could not clearly define if a central or paratracheal lesion was of nodal origin or if it was a lung lesion that had extended beyond the bronchi or towards the mediastinum. This was the situation encountered in 17 of the 43 cases initially selected, and the reason for excluding them from the analysis, even though a diagnosis of malignancy could be made by EBUS-TBNA in all cases. This serves to further reinforce the usefulness of this technique in these types of lesions.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xres232845" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec219439" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres232844" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec219438" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Observation (Case Series)" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-02-13" "fechaAceptado" => "2013-04-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec219439" "palabras" => array:4 [ 0 => "Endoscopic ultrasound" 1 => "Linear endobronchial ultrasound-guided fine needle aspiration" 2 => "Lung cancer" 3 => "Paratracheobronchial lesion" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec219438" "palabras" => array:4 [ 0 => "Ultrasonografía endoscópica" 1 => "Punción guiada por ultrasonografía endobronquial lineal" 2 => "Cáncer de pulmón" 3 => "Lesión paratraqueobronquial" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Linear endobronchial ultrasound (EBUS) allows samples of lesions close to the airways to be obtained, as it enables aspiration to be performed under visual control in real time, opening new possibilities for minimally invasive examination of the mediastinum. While there are many publications on its usefulness in the study of mediastinal or hilar lymphadenopathies, there are few that analyse the role of EBUS-guided transbronchial needle aspiration for the diagnosis of other lesions adjacent to the airways or digestive tract. We describe the characteristics and results obtained in a series of 26 cases of non-nodal lesions of different aetiologies studied by EBUS-guided transbronchial needle aspiration through the airways or oesophagus, demonstrating the usefulness and safety of this technique in the diagnosis of these types of lesions.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La ultrasonografía endobronquial lineal (USEB) facilita la obtención de muestras de lesiones próximas a la vía aérea, ya que permite realizar la punción bajo control visual en tiempo real, abriendo nuevas posibilidades de exploración mínimamente invasiva del mediastino. Mientras que existen multitud de publicaciones acerca de su utilidad en el estudio de adenopatías mediastínicas o hiliares, son escasas aquellas que analizan el papel de la punción guiada por USEB para el diagnóstico de otras lesiones adyacentes a la vía área o digestiva. Describimos las características y los resultados obtenidos en una serie de 26 casos de lesiones no adenopáticas de diferentes etiologías estudiadas mediante punción guiada por USEB a través de la vía aérea o esofágica, demostrando la utilidad y seguridad de esta técnica en el diagnóstico de este tipo de lesiones.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lourido T, et al. Diagnóstico de lesiones paratraqueobronquiales no adenopáticas mediante ecobronquial lineal. Actas Dermosifiliogr. 2013;49:337–9</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2246 "Ancho" => 1301 "Tamanyo" => 386280 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Examples of radiological and ultrasound images from four of the cases from the series. (A and B) Computed tomography (CT) and endoscopic ultrasound images of a mass located in the right upper lobe, aspirated using endobronchial ultrasound, the result of which was adenocarcinoma of pulmonary origin. (C and D) CT and endoscopic ultrasound images of a patient with a pulmonary lesion in the left lower lobe and lymphadenopathy in right mediastinal station 9. Both were aspirated using endobronchial ultrasound via the oesophagus; the result in both was colon cancer metastasis. (E and F) CT and endoscopic ultrasound images of a left hilar mass surrounding the pulmonary artery, with EBUS-guided needle aspiration diagnostic of adenocarcinoma of pulmonary origin. (G and H) CT and endoscopic ultrasound images of a right paratracheoesophageal mass possibly originating in the right upper lobe, with needle aspiration carried out via the oesophagus, resulting in a diagnosis of adenocarcinoma of pulmonary origin. (I and J) CT and endoscopic ultrasound images of a mass located in the right upper lobe infiltrating the mediastinum. EBUS-guided fine needle aspiration was performed with a result of adenocarcinoma of pulmonary origin.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): applications in chest disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.R. Medford" 1 => "J.A. Bennett" 2 => "C.M. Free" 3 => "S. Agrawal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2009.01652.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2010" "volumen" => "15" "paginaInicial" => "71" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19895387" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EBUS-TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.G. Tournoy" 1 => "R.C. Rintoul" 2 => "J.P. Meerbeeck" 3 => "N.R. Carroll" 4 => "M. Praet" 5 => "R.C. Buttery" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lungcan.2008.04.004" "Revista" => array:6 [ "tituloSerie" => "Lung Cancer" "fecha" => "2009" "volumen" => "63" "paginaInicial" => "45" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18514365" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of non-lymph node thoracic lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Yang" 1 => "H. Zhao" 2 => "D.H. Garfield" 3 => "J. Teng" 4 => "B. Han" 5 => "J. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Med" "fecha" => "2013" "volumen" => "1" "paginaInicial" => "14" "paginaFinal" => "21" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchoscopy and needle biopsy techniques for diagnosis and staging of lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Mazzone" 1 => "P. Jain" 2 => "A.C. Arroliga" 3 => "R.A. Matthay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2002" "volumen" => "23" "paginaInicial" => "137" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11901908" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ecobroncoscopia en el diagnóstico de lesiones pulmonares" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Monclou" 1 => "J. Franco" 2 => "P. Ordóñez" 3 => "L. Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2012" "volumen" => "48" "numero" => "Esp Congr" "paginaInicial" => "153" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004900000008/v1_201307270144/S1579212913001122/v1_201307270144/en/main.assets" "Apartado" => array:4 [ "identificador" => "9347" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004900000008/v1_201307270144/S1579212913001122/v1_201307270144/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913001122?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
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| 2024 November | 4 | 5 | 9 |
| 2024 October | 38 | 19 | 57 |
| 2024 September | 44 | 21 | 65 |
| 2024 August | 68 | 39 | 107 |
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| 2022 October | 37 | 37 | 74 |
| 2022 September | 31 | 22 | 53 |
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| 2020 September | 13 | 15 | 28 |
| 2020 August | 24 | 14 | 38 |
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| 2019 March | 54 | 30 | 84 |
| 2019 February | 32 | 12 | 44 |
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| 2018 December | 44 | 21 | 65 |
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| 2018 April | 20 | 7 | 27 |
| 2018 March | 24 | 5 | 29 |
| 2018 February | 22 | 4 | 26 |
| 2018 January | 74 | 5 | 79 |
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| 2017 October | 28 | 9 | 37 |
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| 2017 August | 46 | 9 | 55 |
| 2017 July | 31 | 5 | 36 |
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| 2017 May | 37 | 7 | 44 |
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| 2017 March | 28 | 5 | 33 |
| 2017 February | 24 | 3 | 27 |
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| 2016 December | 30 | 4 | 34 |
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| 2016 March | 1 | 0 | 1 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
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| 2015 August | 46 | 13 | 59 |
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| 2015 June | 35 | 13 | 48 |
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| 2015 March | 26 | 14 | 40 |
| 2015 February | 30 | 10 | 40 |
| 2015 January | 31 | 9 | 40 |
| 2014 December | 26 | 5 | 31 |
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| 2014 October | 42 | 23 | 65 |
| 2014 September | 37 | 17 | 54 |
| 2014 August | 31 | 13 | 44 |
| 2014 July | 30 | 15 | 45 |
| 2014 June | 53 | 15 | 68 |
| 2014 May | 48 | 28 | 76 |
| 2014 April | 37 | 7 | 44 |
| 2014 March | 49 | 13 | 62 |
| 2014 February | 48 | 6 | 54 |
| 2014 January | 36 | 14 | 50 |
| 2013 December | 31 | 10 | 41 |
| 2013 November | 39 | 5 | 44 |
| 2013 October | 1 | 2 | 3 |
| 2013 September | 0 | 3 | 3 |
| 2013 August | 3 | 3 | 6 |
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