Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report

Momen M Wahidi; Felix Herth; Kazuhiro Yasufuku; Ray Wesley Shepherd; Lonny Yarmus; Mohit Chawla; Carla Lamb; Kenneth R Casey; Sheena Patel; Gerard A Silvestri; David J Feller-Kopman

doi:10.1378/chest.15-1216

Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report

Chest. 2016 Mar;149(3):816-35. doi: 10.1378/chest.15-1216. Epub 2016 Jan 12.

Authors

Affiliations

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.

PMID: 26402427
DOI: 10.1378/chest.15-1216

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.

Keywords: endobronchial ultrasound; evidence-based medicine; guidelines; transbronchial needle aspiration.

Publication types

Consensus Development Conference
Practice Guideline
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Bronchoscopy / education
Bronchoscopy / methods*
Carcinoma, Non-Small-Cell Lung / diagnosis*
Clinical Competence
Conscious Sedation
Deep Sedation
Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods*
Evidence-Based Medicine
Humans
Lung Neoplasms / diagnosis*
Lymphatic Diseases / diagnosis
Lymphoma / diagnosis*
Mediastinal Neoplasms / diagnosis*
Needles
Pulmonary Medicine
Sarcoidosis / diagnosis*
Simulation Training
Societies, Medical