Original article
General thoracic
Endobronchial and Endoscopic Ultrasound-Guided Transvascular Biopsy of Mediastinal, Hilar, and Lung Lesions

Presented as a Poster Presentation at the International Conference of the American Thoracic Society, San Diego, CA, May 16–21, 2014.
https://doi.org/10.1016/j.athoracsur.2016.08.111Get rights and content

Background

Endoscopic techniques, including endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS), are the initial approach for the diagnosis and staging of lung cancer and the diagnosis of mediastinal and hilar lesions. Historically, the transvascular approach has been avoided because of concerns of bleeding. Here we review our experience with EBUS and EUS transvascular biopsy of mediastinal, hilar, and lung lesions.

Methods

A prospective research database was used to retrospectively identify and review the records 33 consecutive patients who underwent EBUS and EUS transvascular biopsy in an outpatient setting over 4 years. Complications were identified as significant hematoma seen with endoscopic ultrasound, hemothorax, hemoptysis other than minor, hemodynamic instability, hospital admission, and death.

Results

The biopsies in 14 patients were performed through branches of the pulmonary artery, and 19 were done through the aorta. All EUS biopsies were performed with a 22-gauge needle, and all EBUS biopsies were performed with a 21-gauge needle. Malignancy was diagnosed with specimens from a transvascular biopsy in 16 patients (48.5%). Samples from 8 biopsies (24%) were described as negative for malignancy, and 9 specimens (27%) were described as insufficient. No complications were seen in the immediate postprocedural period, and all 33 patients were discharged home the same day. The median follow-up after the procedure was 12 months, with no complications described. The overall yield was 73%.

Conclusions

In this series, EBUS- and EUS-guided transvascular approach for biopsy of mediastinal, hilar, and lung lesions was not associated with significant complications. However, careful selection of potential candidates and close periprocedural observation are mandatory.

Section snippets

Patients and Methods

Patients were retrospectively identified from a prospective database of the Centre Hospitalier de l’Universite de Montreal Endoscopic Tracheo-Bronchial and Oesophageal Center, Division of Thoracic Surgery, University of Montreal. The Institutional Ethics Committee Board of the Centre Hospitalier de l’Universite de Montreal approved the study.

As described above, the risk of the procedure was deemed acceptable, and specific consent for the transvascular approach was not taken before the procedure.

Results

The study included 33 consecutive patients, 20 women and 13 men, with suspected or proven malignancy who underwent EBUS- or EUS-guided biopsy of lesions distal to the aorta or pulmonary artery branch between January 14, 2011, and September 3, 2015. Patients were a mean age of 64 years (range, 47 to 83 years; Table 1). Nine patients had known extrathoracic malignancy.

The biopsy was performed using a 21-gauge needle under EBUS guidance in 14 patients and using a 22-gauge needle under EUS guidance

Comment

Endoscopic techniques, including EBUS and EUS, are the recommended initial approach for the diagnosis and staging of lung cancer and the preferred method for diagnosis of mediastinal masses and lymphadenopathy. Endoscopic techniques have an excellent safety profile, and severe bleeding from ultrasound-guided biopsy remains exceedingly rare. In a large retrospective multicenter review of 7,345 procedures in 210 facilities by Asano and colleagues [13], hemorrhage was seen in 50 patients (0.68%),

References (27)

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