EBUS - unusual site & unusual use for EBNA
R. Dua*a (Dr), A. Negia (Dr), P. Sivaramakrishnana (Dr), A. Layeka (Dr)
a aiims, Rishikesh, INDIA
* ruchi.pulm@aiimsrishikesh.edu.in
Background
EBUS is usually used to sample benign / malignant mediastinal or peribronchial lesions. We have used it in paravertebral mass lesion and in patients of main stem bronchus occlusion with vascular growths (EBUS-EBNA) where EBLB is risky or leads to bleeding and cEBNA leads to insufficient material for IHC /molecular analysis. Both patients were unwilling/unfit for rigid bronchoscopy procedures under GA
Case 1
A 50 year female presented with main bronchus growth which was highly vascular. EBLB with FOB could not be done, cEBNA failed to get adequate sample on cell block though cytology showed NSCLC .EBUS was then used to sample the lesion using 22 G needle without any significant bleeding and adequate cell block was obtained for further analysis.
Case 2
A 63 year male presented with SVC syndrome and vascular RMB mass. cEBNA was done(4 passes, with ROSE ).In view of mild bleeding EBLB was attempted which led to increased bleeding and withholding of further sampling. cEBNA cell block proved inadequate for molecular/IHC analysis. EBUS was done using 22G needle both from mass & LN and cell blocks prepared from both along with ROSE, thus confirming diagnosis & enabling further analysis.
Case 3
A 60 year male presented with back pain for several months. PET-CT revealed high uptake growth encircling trachea posteriorly. Interventional radiology opinion was taken for transthoracic sampling which was refused. Then patient was taken up for EBUS screening and growth sampled which turned out to be NSCLC. Patient was lost to follow up and no further IHC/molecular analysis was performed.
Conclusion
Rarely when EBLB is risky and cEBNA fails to yield sample for cell block, EBUS-EBNA can be used to get adequate sample. EBUS can be an additional tool for paravertebral masses if transthoracic approach is not possible.
Disclosure of funding source(s): none