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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): A practical approach
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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
There has been wide interest in approaching, visualising and making tissue diagnosis of mediastinal and pulmonary lesions by minimal invasive techniques. In 1960s, the technique of mediastinoscopy was introduced for diagnosis and surgical management of lesions of the mediastinum as well as for lung cancer. This invasive technique required expertise, although it remained a gold standard until modern imaging modalities (CT and PET) became available. Besides, bronchoscopy started being employed widely for obtaining material for exfoliative cytology (e.g. bronchial brushing, bronchial washing, bronchoalveolar lavage) as also for aspiration cytology (e.g. transbronchial needle aspiration, i.e. TBNA). Guided transcutaneous approach for obtaining material for cytologic diagnosis of lung and mediastinal masses has also been practised with good success.
The curved linear array ultrasound attached with endoscope has been used by gastroenterologists for many years but a similar approach for lung and mediastinal lesions called endobronchial ultrasound (EBUS) for obtaining TBNA started about a decade ago. There is a paucity of study material in the form of book or manual on such a sub-specialty which newer centres aspiring to start this technique may find handy and useful.
The book contains 13 chapters which are rationally divided into technical aspects and interpretation of cytologic material obtained. Understandably, the entire procedure and technique require a team work involving the pulmonary physician and a cytologist; accordingly appropriate chapters have been contributed by clinical experts and cytopathologists. The book opens with an introductory chapter connecting the readers with what they already know from traditional knowledge of the field and what they would learn after reading this book. Anatomical considerations on the thorax and mediastinum, and comparison of EBUS-TBNA with other diagnostic modalities from a clinicians point of view are outlined in two separate chapters by clinical experts. These chapters are well supported with tables, schematic illustrations and CT images. In these chapters, fairly detailed technical aspects of performing EBUS-TBNA including the equipment used by pulmonologists and the rapid on-site evaluation (ROSE) of diagnostic material obtained are given, supported with good illustrations of all steps involved. Cytopathologists’ perspective in diagnostic performance of EBUS-TBNA including indications, specimen collection, processing, schematic approach to cytological evaluation, assessment for specimen adequacy are adequately covered in separate chapters. Interpretative aspects based on cytomorphology have been dealt with well in chapters starting with normal and non-neoplastic components, followed by chapters on epithelial and non-epithelial primary and metastatic tumours of the lung and mediastinum, and non-neoplastic lesions of these sites encountered in various cytologic material. A separate chapter is given on contaminants, artifacts and mimics seen in TBNA by this technique which should help the readers in being aware of their possibilities. All these chapters are well supported with schematic representations, tables, CT images, photographs of equipment and valuable photomicrographs.
Since this is the first edition of the book, a critical reader is likely to come across some mistakes in spellings, incomplete sentences and some incorrectly placed paragraphs here and there due to technical mistakes in composing of the manuscript. The authors would surely make efforts to remove these small shortcomings and errors in the next possible reprint edition of the book.
On the whole, the book should find use in teaching hospitals, medical centres and clinical service departments where care of patients with diseases of lungs, mediastinum and thymus is being provided, especially in centres where they are either doing EBUS-TBNA or planning to start it. The book is handy, text is easy to understand and images are mostly good and is worth recommending to readers interested in this subspecialty.
