Endobronchial and/or Endoesophageal Bronchoscopic Ultrasound-Guided Fine Needle Aspiration in the Diagnosis of Mediastinal and Hilar Diseases of Unknown Etiologies

Abstract

Introduction: Diagnosis of mediastinal and hilar lesions represents a problematic issue for long ago, not only due to various structures that occupy this space but also difficult accessibility to such lesions. Mediastinal endosonography – guided FNA is emerged as a new minimally invasive modality for diagnosis of such lesions. Objectives: to evaluate the role of endobronchial and/ or endoesophageal -bronchoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal and hilar diseases of unknown etiologies. Methods: This Prospective observational study was carried out at Tanta University Educational Hospital and Kobri Elkobba Military Hospitals; from December 2017 to December 2019 on thirty patients (19 males; 11 females, age range 17-82 years) presented with undiagnosed mediastinal and or hilar lesions. All patients were subjected to clinical examination, radiological assessment including Chest-X-Ray, CT Chest. Laboratory investigations: CBC, blood urea, serum creatinine and coagulation profile. Twenty-six patients were subjected only to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsies and four patients were subjected to endoscopic ultrasound using EBUS scope-guided fine- needle aspiration (EUS-B-FNA) after EBUS-TBNA, using Pentax Endobronchial ultrasound and a fine needle (22- Gauge). The procedure was done under local anesthesia and conscious sedation ROSE technique was applied for some cases. Results: Definitive diagnosis was reached in twenty-nine cases, achieving diagnostic yield (96.67%). Malignant lesions were the predominant category; twenty (66.67%), while nine (30%) were diagnosed as benign lesions and one (3.33%) case remained un diagnosed. Also, immunohistochemistry played an important role to reach definitive diagnosis in six cases without further sampling. About (12/30; 40%) of patients were passed without any complications while the others recorded controlled complications without any serious events. Conclusion: EBUS and EUS-B-FNA are minimally invasive, complementary and cost effective procedures with high diagnostic yield for mediastinal and hilar lesions. Addition of immunohistochemistry raises diagnostic value of this procedure.