Safety and Efficacy of EBUS-Guided TBNA Through the Pulmonary Artery: A Preliminary Report

Abstract

PURPOSE: The use of endobronchial ultrasound-guided trans-bronchial-needle aspiration (EBUS-TBNA) for diagnosis and staging of benign and malignant thoracic disease has rapidly evolved into the standard of care in most academic centers and many community hospitals. We would like to report our preliminary findings on the safety and efficacy of EBUS-guided TBNA through the pulmonary artery. METHODS: In rare cases, the clinician is faced with extraordinary circumstances in which a minimally invasive approach to the lymph nodes (LN) in stations 5 and 6 is required. We present our findings in four cases, at different institutions, where endobronchial ultrasound was instrumental to reach this goal. RESULTS: We performed four EBUS-guided TBNA of lymph nodes or masses in the location of LN 5 in patients with relative or absolute contraindications for thoracoscopic biopsy. Four patients between 47 and 64 years old underwent real time EBUS and using a 21g needle, tissue was obtained. All samples were abnormal. Three patients had a definitive diagnosis of malignancy and one patient required confirmatory left-thoracoscopy. There were no complications associated with the procedure as verified by ultrasound and chest-X-ray in all cases, and contrasted-CT chest in one case. CONCLUSIONS: EBUS-TBNA has evolved into a safe, accurate, and minimally invasive technique to diagnose and stage malignant thoracic diseases as well as benign diseases. In this report, we evaluated the safety and efficacy of EBUS-TBNA to accurately diagnose mediastinal masses or adenopathy through the pulmonary artery in cases in which patients refused or were poor candidates for surgical or CT -guided procedures due to their associated or perceived morbidity and potential complications. The authors cautiously chose the patients for this procedure as a last resort. However, contrary to common perception, the results were overwhelmingly positive, and there were no complications. CLINICAL IMPLICATIONS: We hypothesize that this preliminary data should warrant further studies to confirm our findings and perhaps consider EBUS-TBNA as an alternative to left-thoracoscopy or Chamberlain procedure in rare circumstances, in selected patients.