CHEST Guidelines-Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Pdf Summary

The 2016 CHEST Guideline and Expert Panel Report outlines the technical aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA), focusing on the procedure’s applications, patient considerations, technology, and proceduralist expertise. EBUS-TBNA allows real-time sampling of mediastinal and hilar structures, improving lung cancer diagnosis and staging. The report examines current literature, using a rigorous evidence-based methodology to provide clinicians with guidance. It addresses clinical questions using the PICO (population, intervention, comparator, outcome) format, resulting in 12 key statements: 7 evidence-based recommendations and 5 consensus-based statements, covering topics like sedation type, needle size, sample methods, and specific case diagnostics like sarcoidosis, tuberculosis, and lymphoma.<br /><br />Key Recommendations:<br />1. Sedation: Both moderate and deep sedation are viable for EBUS-TBNA.<br />2. Ultrasonography: Features may indicate malignancy but tissue samples are still necessary.<br />3. Sampling Techniques: Tissue sampling can be done with or without suction.<br />4. Needle Size: Either 21- or 22-gauge needles are acceptable.<br />5. Procedure Passes: A minimum of three needle passes per site is recommended without rapid on-site evaluation (ROSE).<br />6. ROSE: Not essential for diagnostic yield.<br />7. Molecular Analysis: Additional samples are advised beyond diagnostic needs for molecular testing.<br />8. Training: Simulation-based learning, both low and high fidelity, is suggested for operator training.<br />9. Skill Assessment: Validated EBUS skills assessment tools are recommended.<br /><br />For diseases like sarcoidosis, TB, and lymphoma, EBUS-TBNA provides a minimally invasive alternative to traditional procedures, with acceptable diagnostic yields. The guideline emphasizes the importance of ongoing research to optimize procedural practices and recommends clinicians incorporate the evolving evidence and technology in patient care.

Keywords

EBUS-TBNA

lung cancer diagnosis

mediastinal sampling

sedation

needle size

sampling techniques

sarcoidosis

tuberculosis

lymphoma

molecular analysis