支氣管內視

鏡超音波
 Outline

1. Radial endobronchial ultrasound-guided (R-EBUS)

transbronchial lung biopsy (TBLB)

2. Endobronchial ultrasound-guided transbronchial

needle aspiration (EBUS-TBNA)
Radial endobronchial ultrasound-
guided (R-EBUS)
 RLL tumor？
Pneumonia?

Biopsy:
Cryptococcus
 Lung nodule differential diagnosis

1. Neoplastic: carcinoma, metastasis, lymphoma

2. Infection: TB, aspergillosis, septic emboli,
3. Connective tissue disorder: rheumatoid nodule
4. vascular: AVM (lobulated mass, feeding and draining vessel)
5. Pneumoconiosis, sarcoidosis (bilateral hilar lymph node enlargement)

Biopsy
Observation
Surgical
resection
 Radial probe EBUS

內科學誌 2011：22：223-237
Meta-analysis: diagnostic yield for R-EBUS was 70.6%

Respirology (2017) 22, 443–453

 Lesion size

Nodule size diagnostic yield rate

(JP) <20mm 80%

(JP) >30mm 96%

(TW) overall 73%

Respirology. 2009 Aug;14(6):859-64.

Respiration 2012;84:128–134
Location (tumor location)

Respirology. 2009 Aug;14(6):859-64.

Location (tumor location)

Chest. 2004 Sep;126(3):959-65.

EBUS probe within or adjacent to the lesion

Chest. 2004 Sep;126(3):959-65.

 R-EBUS feature: within / adjacent to

CHIH-HSI KUO, SHU-MIN LIN, FU-TSAI CHUNG, et al.

Ultrasound in Med. & Biol., Vol. 37, No. 11, pp. 1755–1761, 2011
 R-EBUS feature

CHIH-HSI KUO, SHU-MIN LIN, FU-TSAI CHUNG, et al.

Ultrasound in Med. & Biol., Vol. 37, No. 11, pp. 1755–1761, 2011
 Diagnostic yield of EBUS-guided TBLB

CHIH-HSI KUO, SHU-MIN LIN, FU-TSAI CHUNG, et al.

Ultrasound in Med. & Biol., Vol. 37, No. 11, pp. 1755–1761, 2011
 R-EBUS in cryobiopsy

Chih-Hao Chang,Chung-Shu Lee, Shih-Hong Li, Fu-Tsai Chung,

Canadian Respiratory Journal Volume 2017DOI: 10.1155/2017/7170687
 R-EBUS in cryobiopsy

Chih-Hao Chang,Chung-Shu Lee, Shih-Hong Li, Fu-Tsai Chung,

Canadian Respiratory Journal Volume 2017DOI: 10.1155/2017/7170687
Bronchus sign: the bronchus leading to the lesion)

CHEST 2007; 131:1788–

1793
Endobronchial Ultrasonography [精装] ~ Noriaki Kurimoto (编者), David Fielding (编者), Ali
Musani (编者)
 Ground glass nodule

Radiology. 2013 Jan;266(1):304-17

EBUS for for ground glass opacity
EBUS for for ground glass opacity

Respiratory Medicine Case Reports 12 (2014) 19-21

Pathology: adenocarcinoma
European Respiratory Journal 2015 45: 1661-1668
Endobronchial ultrasound-guided
transbronchial needle aspiration
(EBUS-TBNA)
 NCCN guideline

EBUS-TBNA: Nodal sations 2R/2L, 4R/4L, 7, 10R/10L

張志誠 內科學誌 2011：22：223-237
張志誠 內科學誌 2011：22：223-237
 EBUS-TBNA

Lung Cancer. 2005 Dec;50(3):347-54. Epub 2005 Sep 19

 EBUS-TBNA lymph nodes

100 patients, stage 1 NSCLC

Chest. 2008 Apr;133(4):887-91. Epub 2008 Feb 8.

Chest. 2008 Sep;134(3):672; author reply 672-3.
EBUS -
TBNA
 CT: inappropriate for mediastinal LN

Eur J Cardiothorac Surg. 2007 Jul;32(1):1-8. Epub 2007 Apr 19.

Ann Intern Med. 2003 Dec 2;139(11):879-92.

 PET/CT

Eur J Cardiothorac Surg. 2009 Sep;36(3):440-5. Epub 2009 May 22.

 EBUS-TBNA: High sensitivity and specificity

Chest. 2006 Sep;130(3):710-8.

Chest. 2006 Sep;130(3):710-8.

Lung Cancer. 2005 Dec;50(3):347-54. Epub 2005 Sep 19
 EBUS-TBNA for Lung Cancer with
Non-Enlarged Lymph Nodes

43 lung
cancer
patients

Chih-Hsi Kuo, Hao-Cheng Chen, Fu-Tsai Chung

PLoS One. 2011 Feb 25;6(2):e16877.
JAMA. 2010 Nov 24;304(20):2245-52.
EBUS-TBNA: fewer unnecessary thoracotomies

JAMA. 2010 Nov 24;304(20):2245-52.

EBUS-TBNA for the diagnosis of sarcoidosis

Respiratory Medicine (2009) 103, 1796-1800

EBUS elastography
 EBUS elastography

Jpn J Clin Oncol 2014;44(10)956–962

Ching-Kai Lin J Formos Med Assoc. 2018 Jul 11