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Background: Modalities to improve tissue acquisition during endobronchial ultrasound‑guided transbronchial needle aspiration (EBUS‑TBNA) have been investigated. Endobronchial ultrasound‑guided transbronchial mediastinal cryobiopsy (EBUS‑TMC) is a modality to obtain larger histological samples by inserting a cryoprobe into the mediastinal lesion. We aimed to study the diagnostic yield and safety of EBUS‑TMC. Methods: We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta‑analysis to calculate the diagnostic yield of EBUS‑TMC and compare it with EBUS‑TBNA. Results: Following a systematic search, we identified 14 relevant studies (869 patients undergoing EBUS‑TMC and EBUS‑TBNA). We then performed a meta‑analysis of the diagnostic yield of EBUS‑TMC and EBUS‑TBNA from studies wherein both procedures were performed. The pooled diagnostic yield of EBUS‑TMC was 92% (95% confidence interval [CI], 89%–95%). The pooled diagnostic yield of EBUS‑TBNA was 81% (95% CI, 77%–85%). The risk difference in yield was 11% (95% CI, 6%–15%, I 2 = 0%) when EBUS‑TMC and EBUS‑TBNA were compared. The only complication reported commonly with EBUS‑TMC was minor bleeding. The complication rate was comparable with EBUS‑TBNA. Conclusion: EBUS‑TMC provides a greater diagnostic yield with a similar risk of adverse events compared to EBUS‑TBNA. Future studies are required to clearly establish which patients are most likely to benefit from this modality. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 33-year-old male diagnosed with superior vena cava obstruction (SVCO) caused by mediastinal tuberculosis, a rare benign etiology of this condition. It highlights the diagnostic and therapeutic challenges faced, particularly the successful endovascular stenting procedure combined with anti-tubercular therapy, which resolved the patient's symptoms.

Introduction: Elastography is a non-invasive tool that may allow differentiation between benign and malignant lymph nodes during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA). In tuberculosis (TB) endemic areas, clinicoradiological features of mediastinal TB and sarcoidosis often overlap, rendering an accurate diagnosis challenging. There is interest in the identification of modalities to aid in this differentiation. There are currently no published data on the utility of EBUS-elastography in differentiating between TB and sarcoidosis. Methods: Subjects undergoing EBUS-TBNA were prospectively enrolled, and elastography features were observed. Subjects with definitive diagnosis of TB or sarcoidosis were enrolled. The elastography features recorded included the three-colour classification patterns and strain ratio. Results: We enrolled 96 subjects with a definitive diagnosis (53 with TB and 43 with sarcoidosis). Of the 27 patients in whom the lymph nodes were classified as type 1 on endobronchial ultrasound elastography colour pattern, 17 had a diagnosis of TB (62.9%), while 10 were sarcoidosis (37%). For type 2 lymph nodes, 20/45 (44.4%) were TB and 25/45 (55.6%) were sarcoidosis. Type 3 lymph nodes were TB in 16/24 (66.7%) and sarcoidosis in 8/24 (33.3%). In classifying type 1 as 'sarcoidosis' and Type 3 as 'tubercular', the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 48.5%, 55.6%, 66.7%, 37%, and 0.51, respectively. The strain ratio (Median [IQR]) was 1.29 (0.37–5.98) in TB and 2.10 (0.83–4.52) in sarcoidosis group (P = 0.48). Conclusion: Ultrasound elastographic lymph node characteristics have a poor diagnostic utility to differentiate between TB and sarcoidosis during EBUS-TBNA. [ABSTRACT FROM AUTHOR]

Background: There is a lack of data on the prevalent practices of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in India. Aim: To study the current practices of EBUS-TBNA in India. Methods: This survey was an online questionnaire designed on the Google forms interface. The survey included various questions related to demographics, sedation, analgesia and anesthesia, technical aspects, and infection control related to the procedure of EBUS-TBNA. Results: Data from 134 respondents (mean age: 42.2 years) were analyzed. Most (97.8%) were pulmonologists or physicians, and a majority (94.8%) practicing in either a private multi-specialty setting or medical college. 40.3% had received procedure training at a formal training program. Mild/moderate sedation was the most common strategy (70.1%). Midazolam (76.7%), Fentanyl (76.0%), followed by propofol (46.5%), were the most frequent drugs, and 82.8% preferred combination sedation. 26.1% used cricothyroid lignocaine injection, and the use of 1% or 2% lignocaine for spray-as-you-go administration was similar. The oral route was preferred, while the laryngeal mask airway was the most common airway conduit under general anesthesia. Suspected granulomatous mediastinal lymphadenopathy (TB/sarcoidosis) (67.2%), followed by lung cancer (32.8%), were the most common indications of EBUS-TBNA. 81.3% performed EBUS-TBNA for lung cancer staging. 21 G needle was preferred (64.9%), and vacuum suction was common (80.6%). 55.2% routinely performed ROSE. Alcohol fixed glass slide smears were the most common method (93.1%) for cytological preparation. 49.3% also performed EUS-B-FNA. 76.9% routinely obtained endo bronchial biopsy and transbronchial lung biopsy in patients with suspected sarcoidosis. Elastography was infrequently used. Nearly three-fourths (77.6%) reused EBUS needles. Conclusion: There is practice variability in the multiple aspects related technical performance of EBUS-TBNA. Evidence-based guidelines addressing the multiple technical aspects are required to standardize the practice of EBUS-TBNA. [ABSTRACT FROM AUTHOR]

Introduction: Sarcoidosis is a multisystem granulomatous disease with a varied clinical presentation. We describe the clinical characteristics of patients with sarcoidosis from a tuberculosis (TB) endemic setting. Methods: We performed an analysis of the sarcoidosis database at a tertiary care facility in North India. Results: Of the 327 patients, 50.8% were male, with a mean age of 42.8 years (range: 16-70 years). Females were significantly older. 42.6% had comorbidities, of which diabetes (17.1%) was most common. More than half (57.1%) were obese. Serum angiotensin-converting enzyme levels were elevated in 186 (57.9%). Eleven (3.8%) had hypercalcemia, while hypercalciuria was present in 54 (31.7%). The majority (89.9%) were tuberculin skin test negative (<10 mm induration), while 71.9% were tuberculin anergic. 47.7% had normal spirometry, while a restrictive impairment was the most common abnormality (44.6%). Obstruction on spirometry was present in 8.3%. Nearly half (160, 49%) had involvement of an extrapulmonary site. Most patients were (96%) symptomatic. Cough, shortness of breath, fatigue, weight loss, and fever were the predominant symptoms. A majority had Stage 1 (47.7%) sarcoidosis. Two hundred and eighty-seven (87.8%) patients underwent bronchoscopy or endosonographic (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] or transesophageal bronchoscopic ultrasound-guided fine-needle aspiration [EUS-B-FNA]) sampling. A histopathological diagnosis with the demonstration of granulomas was achieved in 90.8%. The diagnostic yield of EBUS-TBNA/EUS-B-FNA was 77.4%. In 13.5% of patients, necrotizing granulomas were present in tissue samples. Conclusion: The clinical profile of patients with sarcoidosis in TB endemic settings has certain differences from nonendemic populations. Bronchoscopy and endosonography allow a confident diagnosis in the majority of patients. [ABSTRACT FROM AUTHOR]

Background: Guidelines for flexible bronchoscopy in adults recommend both Cricothyroid and Spray‑as‑you‑go method as the acceptable techniques for lignocaine administration. No studies have compared these two methods for topical anesthesia during endobronchial ultrasound‑guided transbronchial needle aspiration (EBUS‑TBNA). Objectives: Co‑primary outcomes were the comparison of cough count and operator‑rated overall procedure satisfaction on a Visual Analog Scale (VAS) between the groups. The secondary outcomes were cumulative lignocaine dose, time from bronchoscope introduction to crossing the vocal cords, procedure duration, and complications between the groups. Methods: Consecutive participants (age >18 years) undergoing EBUS‑TBNA were randomized (1:1) to either cricothyroid or spray‑as‑you‑go methods for lignocaine administration. Results: Three hundred and sixty‑five participants were randomized (183: Cricothyroid and 182: Spray‑as‑you‑go). Cough count till reaching carina (median [interquartile range]) was significantly lower (cricothyroid, 1 [0–2] vs. spray‑as‑you‑go, 4 [2–6], P < 0.001) and operator rated overall procedure satisfaction, on VAS (mean ± standard deviation) (cricothyroid, 7.96 ± 1.48 vs. spray‑as‑you‑go, 7.29 ± 1.48, P < 0.001) significantly greater in the cricothyroid group. Cumulative lignocaine dose (163.28 ± 31.50 mg vs. 177.0 ± 30.12 mg, P < 0.0001) and time from bronchoscope introduction to crossing the vocal cords (20.80 ± 11.21 s vs. 38.08 ± 15.26 s, P < 0.001) was significantly lower in the cricothyroid group. Procedure duration was similar in both the groups. Minor complications occurred in three patients in cricothyroid and six patients in the spray‑as‑you‑go group (P = 0.31). Conclusions: Cricothyroid lignocaine administration is associated with less cough and superior operator‑rated procedure satisfaction during EBUS‑TBNA, at a lower cumulative lignocaine dose administered. [ABSTRACT FROM AUTHOR]

The article focuses on the Endoscopic Ultrasound (EUS)/Fine Needle Aspiration (FNA) is a real-time fine-needle aspiration procedure, through the esophagus, providing access to left paratracheal, and paraesophageal lymph node station. Topics include it is a highly sensitive, accurate, and minimally invasive method; and its diagnostic yield for sarcoidosis varies between 77 percent and 94 percent (2, 3).