ORIGINAL ARTICLE
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
Antonio Bugalhoa,b,c,
, Dalila Ferreiraa, Rita Baratad, Cristina Rodriguesd, Sara S. Diase, Filomena Medeirosf, Luis Carreiroa
Corresponding author
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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Dias, Filomena Medeiros, Luis Carreiro" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Antonio" "apellidos" => "Bugalho" "email" => array:1 [ 0 => "antonio.bugalho@hbeatrizangelo.pt" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Dalila" "apellidos" => "Ferreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rita" "apellidos" => "Barata" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Cristina" "apellidos" => "Rodrigues" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Sara S." 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It is also a valid method for diagnosing extraluminal lesions adjacent to the tracheobronchial tree.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">to evaluate our eBUS-tBNA performance regarding diagnostic yield, safety and learning curve for lung cancer diagnosis and staging.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introdução</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Material e métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusão</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">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. <a class="elsevierStyleInterRef" id="intr0005" href="http://dx.doi.org/">http://dx.doi.org/</a></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Alberg AJ, Ford JG, Samet JM. epidemiology of lung cancer: AccP evidence-based clinical practice guidelines. chest 2007; 132:29S-55S." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ferlay J, Parkin DM, Steliarova-Foucher e. estimates of cancer incidence and mortality in europe in 2008. eur J cancer. 2010; 46:765-781." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Silvestri GA, Gould MK, Margolis ML, tanoue Lt, Mccrory D, toloza e, Detterbeck F. 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Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station? chest. 2008;134:368-374." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000001900000005/v3_201405231121/S217351151300105X/v3_201405231121/en/main.assets" "Apartado" => array:4 [ "identificador" => "9710" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001900000005/v3_201405231121/S217351151300105X/v3_201405231121/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151300105X?idApp=UINPBA00004E" ]
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