Implementing EBUS TBNA: first experience and review of literature

Lung cancer has a very dismal prognosis and careful diagnosis and staging is of outmost importance. EBUS has become a cornerstone investigation for diagnosis and staging and current guidelines stress that there is a steep learning curve when introducing this tech- nique in practice (only 30 procedures are considered necessary). Over a period of 10 months a total of 21 patients have been addressed to our unit for an EBUS TBNA procedure. Only three were referred for staging purposes (for lung, digestive and cervix cancers) the others being primary diagnostic approaches where simpler procedures had previously failed. Procedures were initially performed under local anesthesia (3 cases) then under general anesthesia and jet ventilation using a laryngeal mask approach. Mediastinal lymph node group 7 was the most frequent target (9 cases) followed by group 4R (8 cases) and peribronchial tumoral processes (7 cases); one case did not required any needle-aspiration. On average each examination resulted in the sampling of 1.4 targets. There were no significant procedure related severe adverse events. Although 21 G cytology needles were used, adequate histological samples were obtained for 11 cases and cytology was the examination of choice for 9 cases. The pathology/cytology results were retrospectively assessed as satisfactory for 15 cases (confirmed neoplastic or other disease) and inconclusive for 5 cases. Non neoplastic disorders were represented by sarcoidosis, tuberculosis and bronchogenic cyst (3 cases). The procedure can be considered fast and safe; trained pathology personnel play an extremely important role: presently referrals are rare for staging purposes.