Lindfield Matthew, Lloyd Angus, George Vineeth, Grainge Christopher, Twaddell Scott, Arnold David
Department of Respiratory and Sleep Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
The Australian National University, Canberra, Australian Capital Territory, Australia.
Intern Med J. 2025 Aug;55(8):1333-1338. doi: 10.1111/imj.70113. Epub 2025 Jun 26.
BACKGROUND: The combined use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transoesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is preferred in the diagnosis and staging of non-small cell lung cancer (NSCLC); however, there is limited utilisation of EUS-B-FNA in Australia. With a National Lung Cancer Screening program (NLCSP) commencing in 2025, additional diagnostics may be required by bronchoscopists. AIMS: We describe the endoscopic model of care offered and outcomes achieved by Respiratory Physicians experienced in EUS-B-FNA practicing in a regional Australian tertiary referral hospital. METHODS: Adult patients within the Hunter New England Local Health District (HNELDH) who underwent a diagnostic/staging EBUS-TBNA or EUS-B-FNA procedures, as recorded in a prospectively collected procedural database from 2016 to 2022, were included. RESULTS: 1564 patients (688 female), median age 68 years had a diagnostic or staging EBUS-TBNA and/or EUS-B-FNA (1268 EBUS-TBNA, 262 EUS-B-FNA and 34 combined). The diagnostic yield for procedures performed with an indication of suspected lung malignancy was as follows: EBUS-TBNA: 75.5%, EUS-B-FNA: 85.7%, and combined procedure: 61.1%. Three major infectious complications were observed in EUS-B-FNA (1.15%) and two in EBUS-TBNA (0.16%). These complications precede the institution's policy of pre-procedural antibiotic prophylaxis started in 2021. CONCLUSION: EUS-B-FNA can be performed safely by competent EBUS-TBNA respiratory physicians provided that prospective data and complication monitoring are in place.
背景:在非小细胞肺癌(NSCLC)的诊断和分期中,支气管内超声引导下经支气管针吸活检(EBUS-TBNA)与经食管内镜超声引导下支气管镜引导细针穿刺活检(EUS-B-FNA)联合使用是首选方法;然而,EUS-B-FNA在澳大利亚的应用有限。随着2025年国家肺癌筛查计划(NLCSP)的启动,支气管镜检查医生可能需要更多的诊断方法。 目的:我们描述了在澳大利亚一家地区三级转诊医院中,有EUS-B-FNA经验的呼吸内科医生提供的内镜护理模式及取得的结果。 方法:纳入2016年至2022年在Hunter New England地方卫生区(HNELDH)接受诊断/分期EBUS-TBNA或EUS-B-FNA手术的成年患者,这些数据记录在一个前瞻性收集的手术数据库中。 结果:1564例患者(688例女性),中位年龄68岁,接受了诊断或分期EBUS-TBNA和/或EUS-B-FNA(1268例EBUS-TBNA,262例EUS-B-FNA,34例联合手术)。以疑似肺恶性肿瘤为指征进行的手术诊断率如下:EBUS-TBNA为75.5%,EUS-B-FNA为85.7%,联合手术为61.1%。EUS-B-FNA观察到3例主要感染并发症(1.15%),EBUS-TBNA观察到2例(0.16%)。这些并发症发生在该机构2021年开始的术前抗生素预防政策之前。 结论:只要有前瞻性数据和并发症监测,有能力的EBUS-TBNA呼吸内科医生可以安全地进行EUS-B-FNA。
Am J Respir Crit Care Med. 2024-3-15
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