Technical aspects of endobronchial ultrasound guided transbronchial needle aspiration: Chest guideline and expert panel report
S'appuyant sur une revue systématique de la littérature publiée jusqu'en octobre 2014, un groupe d'experts de l'"American College of Chest Physicians" présente ses recommandations pour réaliser une ponction transbronchique à l'aiguille guidée par échographie endobronchique
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. Many publications about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document is to examine the current literature on the technical aspects of EBUS-TBNA as related to patient, technology, and proceduralist’s 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 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, supplemented by manual searches. References were screened for inclusion and recognized document evaluation tools were utilized 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 on the optimal performance of this effective procedure.
Chest , article en libre accès, 2014