CHEST Guidelines-Technical-Aspects-of-Endobronchial-Ultrasound-Guid

Technical-Aspects-of-Endobronchial-Ultrasound-Guid

Pdf Summary

The "Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA)" report by the CHEST Guideline and Expert Panel provides evidence-based guidance on this minimally invasive procedure used for diagnosing and staging mediastinal and hilar lymph nodes. EBUS allows real-time visualization and sampling through bronchoscopy and can be pivotal in conditions such as lung cancer, sarcoidosis, tuberculosis, and lymphoma.<br /><br />The guidelines, derived from a systematic review of existing literature using the PICO (population, intervention, comparator, and outcome) framework, resulted in several key recommendations. Notably, they endorsed using either moderate or deep sedation during EBUS-TBNA. They also highlighted that while ultrasonographic features might help predict malignancy, tissue samples remain necessary for definitive diagnosis. The choice between 21- or 22-gauge needles is acceptable, and the absence of a rapid on-site evaluation (ROSE) does not adversely impact diagnostic yield but may increase the number of necessary passes.<br /><br />For proceduralists, the guideline suggests incorporating simulation-based training to achieve proficiency in performing EBUS-TBNA. The report underscores EBUS-TBNA's role in diagnosing sarcoidosis and tuberculosis when mediastinal or hilar lymph node sampling is indicated. For lymphoma diagnosis, EBUS-TBNA is suggested as an initial diagnostic test, acknowledging the procedure’s minimally invasive nature, although with some limitations in definitive subtype and histologic grading.<br /><br />The report emphasizes the importance of continued research in optimizing EBUS-TBNA use and suggests regular updates to guidelines as technology and understanding of EBUS-TBNA evolve. The guidelines are supported by the American College of Chest Physicians and various other medical societies, emphasizing their applicability to current medical practice.

Keywords

EBUS-TBNA

bronchoscopy

lung cancer

sedation

ultrasonographic features

needle gauge

simulation-based training

lymphoma diagnosis

guideline updates

American College of Chest Physicians