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Vol. 19. Issue 5.
Pages e1-e8 (September - October 2013)
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Vol. 19. Issue 5.
Pages e1-e8 (September - October 2013)
ORIGINAL ARTICLE
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Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer diagnosis and staging in 179 patients
Contributo da punção aspirativa transbrônquica guiada por ecoendoscopia brônquica no diagnóstico e estadiamento de cancro do pulmão em 179 doentes
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Antonio Bugalhoa,b,c,
Corresponding author
, Dalila Ferreiraa, Rita Baratad, Cristina Rodriguesd, Sara S. Diase, Filomena Medeirosf, Luis Carreiroa
a Unidade de Técnicas Invasivas Pneumológicas, Pneumologia II, Hospital Pulido Valente, Lisboa, Portugal
b Unidade de Pneumologia de Intervenção, Hospital Beatriz Ângelo, Loures, Portugal
c Centro de Estudos de Doenças Crónicas (CEDOC), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
d Serviço de Cirurgia Torácica, Hospital Pulido Valente, Lisboa, Portugal
e Departamento Universitário de Saúde Pública, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
f Serviço de Anatomia Patológica, Hospital Pulido Valente, Lisboa, Portugal
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Abstract
Background

Linear endobronchial ultrasound-guided transbronchial needle aspiration (eBUStBNA) is an important minimally invasive procedure for non-small cell lung cancer (NScLc) staging. It is also a valid method for diagnosing extraluminal lesions adjacent to the tracheobronchial tree.

Aim

to evaluate our eBUS-tBNA performance regarding diagnostic yield, safety and learning curve for lung cancer diagnosis and staging.

Material and methods

All patients undergoing eBUS-tBNA for lung cancer diagnosis or staging were included. they were divided into three different groups: paratracheal and parabronchial masses sent for diagnosis (Group 1); peripheral lung lesions with abnormal mediastinal lymph nodes sent for diagnosis and staging (Group 2); NScLc patients sent for mediastinal staging (Group 3). the learning curve was assessed for yield, accuracy, procedure time, size and number of lesions punctured per patient

Results

A total of 179 patients were included and 372 lesions were punctured. the overall yield and accuracy were 88% and 92.7%, respectively. In Group 1, eBUS-tBNA was performed in 48 patients and sensitivity was 86.1% and accuracy was 87.5%. For the 87 patients included in Group 2, yield was 86.7%, accuracy was 93.1% and cancer prevalence was 51.7%. the diagnostic yield and accuracy in Group 3 was 95% and 97.7% respectively. eBUS-tBNA practice led to an increase number of sites punctured per patient in a shorter time, without complications.

Conclusion

eBUS-tBNA is an effective method for diagnosing and staging lung cancer patients. the procedure is clearly safe. Handling and performance improves with the number of procedures executed.

Keywords:
Lung cancer
Endobronchial
ultrasound
Fine needle aspiration
Diagnosis
Staging
Learning curve
Resumo
Introdução

A punção aspirativa transbrônquica guiada por ecoendoscopia brônquica linear (eBUS-tBNA) é um importante procedimento minimamente invasivo para o estadiamento do cancro do pulmão de não pequenas células (cPNPc). É, também, um método válido para o diagnóstico de lesões extraluminais adjacentes à árvore traqueobrônquica.

Objetivo

Avaliar o nosso desempenho na execução de eBUS-tBNA relativamente à rentabilidade diagnóstica, segurança e curva de aprendizagem no diagnóstico e estadiamento do cancro do pulmão.

Material e métodos

Incluímos todos os doentes submetidos a eBUS-tBNA para diagnóstico ou estadiamento de neoplasia pulmonar. estes foram posteriormente divididos em 3 grupos diferentes: diagnóstico de massas paratraqueais e parabrônquicas (Grupo 1); diagnóstico e estadiamento de lesões pulmonares periféricas com gânglios mediastínicos aumentados (Grupo 2); estadiamento de doentes com cPNPc (Grupo 3). A curva de aprendizagem foi avaliada em função da sensibilidade diagnóstica, precisão, duração do procedimento, tamanho e número de lesões puncionadas por doente.

Resultados

Foram incluídos 179 doentes e puncionadas 372 lesões. A sensibilidade e precisão globais foram 88% e 92.7%, respetivamente. No Grupo 1, 48 doentes foram submetidos ao procedimento com uma sensibilidade de 86,1% e precisão de 87,5%. No Grupo 2, com 87 doentes, a sensibilidade foi de 86,7%, a precisão de 93,1% e a prevalência de neoplasia de 51,7%. No Grupo 3, a sensibilidade e precisão foram 95 e 97,7%, respetivamente. A prática de eBUS-tBNA conduziu a um maior número de locais puncionados por doente, em menor período de tempo, sem complicações.

Conclusão

EBUS-TBNA é um método eficaz para o diagnóstico e estadiamento de doentes com cancro do pulmão. É claramente um exame seguro. O número de procedimentos realizados melhora o manuseamento e desempenho da técnica.

Palavras-chave:
Neoplasia do pulmão
ecoendoscopia brônquica
Punção aspirativa
Diagnóstico
estadiamento
curva de aprendizagem
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Please cite this article as: Bugalho A, Ferreira D, Barata R, Rodrigues C, Dias SS, Medeiros F, et al. Contributo da punção aspirativa transbrônquica guiada por ecoendoscopia brônquica no diagnóstico e estadiamento de cancro do pulmão em 179 doentes. Rev Port Pneumol 2014. http://dx.doi.org/

Copyright © 2012. Sociedade Portuguesa de Pneumologia
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