EBUS

Question 1

What modes of sedation are recommended for EBUS?

Answer 1

Moderate or Deep Sedation

Question 2

If ROSE is unavailable, how many samples should be obtained?

Answer 2

A minimum of 3

Question 3

What is the recommended minimum ETT size for EBUS TBNA?

Answer 3

8

Question 4

What ultrasound signs are indicative of malignancy on EBUS? If all are absent what is the rate of negative for malignancy?

Answer 4

Round shape
Distinct Margins
Heterogeneous echogenicity
Central necrosis sign
96% of lymph nodes were benign when all 4 are not present.

Question 5

How can vascular patterns help discern malignant nodes on EBUS?

Answer 5

> 4 vessels (grade 2 and 3) sensitivity 87.7% and specificity 69.6% for malignancy.
One central nodal vessel is associated with benign findings

Question 6

What findings are more consistent with sarcoid vs malignancy vs TB in EBUS?

Answer 6

Lymph nodes with homogeneous echogenicity and a germinal center were more likely to indicate sarcoidosis than lung cancer

coagulation necrosis and heterogeneous echogenicity within lymph nodes were more likely to be present in TB as opposed to sarcoidosis

Question 7

What is the % malignancy sensitivity rate in EBUS TBNA based on number of passes?

Answer 7

69.8%, 83.7%, 95.3%, and 95.3% for one, two, three, and four passes, respectively.

Question 8

What is the benefit of ROSE from a procedural standpoint?

Answer 8

May reduce the number of needle aspirations needed.

Question 9

If molecular testing is desired how many passes should be obtained on EBUS TBNA?

Answer 9

More than required for diagnosis (number unknown)

Question 10

What are the odds of being able to perform genetic analysis of NSCLC off EBUS TBNA?

Answer 10

EGFR 94.5%
ALK 94.9%
Complete genetic 90%

Question 11

What are the borders for station 1 lymph nodes?

Answer 11

Upper border:
lower margin of cricoid cartilage

Lower border:
clavicles bilaterally and, in the midline, the upper border of the manubrium

Sidedness:
Tracheal midline

Question 12

What are the borders of station 2 lymph nodes?

Answer 12

Upper border:
apex of the lung and pleural space, and in the midline, the upper border of the manubrium

Lower border:
intersection of caudal margin of innominate vein with the trachea for the right and superior border of the aortic arch for left

Sidedness:
Remains right sided until left border of trachea (like station 4)

Question 13

What are the borders of station 4 lymph nodes?

Answer 13

Upper border:

Lower border:

Sidedness: