Page 89 - ECBIP 2021_Program

MODERATED VIDEO SESSION
ENDOBRONCHIAL ULTRASOUND - TRANSBRONCHIAL CRYO NODE BIOPSY (EBUS - TBCNB)
Hari Kishan Gonuguntla
Yashoda Hospitals, Hyderabad, India
VID03
Introduction: Since the advent of Endobronchial Ultrasound-Transbronchial Needle Aspiration (EBUS-TBNA), this method has become the preferred choice in evaluating malignant lymph nodes and staging of lung cancer. Nevertheless, there is a growing demand for larger tissue samples, particularly for molecular analysis.
Methods: For EBUS-TBCNB, after initial puncture with the EBUS-TBNA needle, a 1.1 mm flexible cryoprobe (Erbecryo 20402- 401) was introduced into the working channel of the EBUS bronchoscope.The probe was advanced slowly towards the puncture site and pushed gently through the previous puncture site. Under real-time ultrasound guidance by the EBUS bronchoscope, the cryoprobe position confirmed within the lymph node, activated for 3 seconds, and the scope unit with the probe inside was pulled out.The specimens were thawed in saline and fixed in formalin.After obtaining the tissue,the puncture site was examined for presence of bleeding.
Results: In our first case, HPE showed non-caseating epithelioid granuloma with giant cells and fibrosis consistent with Sarcoidosis.The second case was diagnosed as adenocarcinoma with positivity for ROS1(D4D6).The third case showed features of metastatic Adenocarcinoma from the breast; (positive for Her2, ER, and GATA3).The fourth case diagnosed as Tuberculosis (necrotising granuloma in the histopathology, stain with Ziehl-Neelsen that showed few rod-shaped bacilli).
Conclusion: This article describes the feasibility, technical details, and complications of using EBUS-TBCNB done in four patients with mediastinal adenopathy needing tissue sampling.
Figure 1
Figure 2: Case 1 – (A) Non-contrast CT thorax demonstrating sub-carinal and hilar nodes, (B) Non caseating epithelioid granuloma with giant cells and fibrosis. H&E 40x, CD4
cells (C) are more evident than CD 8 cells (D) while few B lymphocytes are highlighted with CD 20 (E); Case 2 – (F) Contrast CT thorax showing left hilar mass with paratracheal lymph nodes, (G) Adenocarcinoma cells, H&E ,10x (H)
with positivity for ROS1(D4D6) ,10x; Case 3 – (I) Contrast CT showing left interlobar node, (J) Metastatic Carcinoma from breast,H&E,10x,Tumour cells are positive for Her2 (K) ,ER (L) and GATA3 (M); Case 4 – (N) Non-contrast CT of right para- hilar lesion with sub-carinal lymph node, (O) Necrotising Granuloma,H&E,40x (P) Ziehl-Neelsen stain highlights few pink rod shaped bacilli (red arrow), CD8 cells (Q) are more evident than CD 4 cells (R) while few B lymphocytes are highlighted with CD 20 (S)
ECBIP 2021 89
6th European Congress
for Bronchology and Interventional Pulmonology
OCTOBER ECBIP 15 - 17
ATHENS - GREECE 2021
Book of Abstracts