Momen M Wahidi1, Felix Herth2, Kazuhiro Yasufuku3, Ray Wesley Shepherd4, Lonny Yarmus5, Mohit Chawla6, Carla Lamb7, Kenneth R Casey8, Sheena Patel9, Gerard A Silvestri10, David J Feller-Kopman5. 1. Duke University Medical Center, Division of Pulmonary and Critical Care Medicine, Durham, NC. Electronic address: momen.wahidi@duke.edu. 2. Division of Pulmonary and Critical Care Medicine, University of Heidelberg, Heidelberg, Germany. 3. Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. 4. Virginia Commonwealth University Medical Center, Richmond, VA. 5. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 6. Division of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. 7. Division of Pulmonary and Critical Care Medicine, Lahey Clinic Hospital, Burlington, MA. 8. Division of Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, WI. 9. CHEST, Glenview, IL. 10. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
Abstract
BACKGROUND: Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. METHODS: Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. RESULTS: Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. CONCLUSIONS: Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure.
BACKGROUND: Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. METHODS: Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. RESULTS: Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. CONCLUSIONS: Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure.
Authors: Ala-Eddin S Sagar; Bruce F Sabath; George A Eapen; Juhee Song; Mathieu Marcoux; Mona Sarkiss; Muhammad H Arain; Horiana B Grosu; David E Ost; Carlos A Jimenez; Roberto F Casal Journal: Chest Date: 2020-06-17 Impact factor: 9.410