Name: substernal thyroid biopsy using endobronchial ultrasound-guided transbronchial needle aspiration
Uploaded: 2014-11-10T13:00:00
Description: Watch this Scientific Journal Video about Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration at JoVE.com

We thank Dr. Gerard Silvestri and &#8220;Proceedings of The American Thoracic Society&#8221; for their permission to reproduce their schematic diagram of the Convex-Probe Endobronchial Ultrasound (Figure 2; Proc Am Thorac Soc Vol 6. pp 180&#8211;186, 2009). We thank &#8220;American College of Chest Physicians&#8221; for their permission to reproduce the image of the substernal thyroid biopsy (Figure 4; CHEST Journal 137.6 (2010): 1435-1436). We thank Kelly Watson, RN, for her help in preparation of the procedure video.

下面列出的协议遵循机构（美国纽约州立大学布法罗分校罗斯威尔帕克癌症研究所，NY）的指导方针。 1，前期准备工作<ol><li>在中度镇静进行支气管内超声引导下经支气管针吸活检（EBUS-TBNA），监测麻醉护理（MAC），或深度镇静和全身麻醉。 注：病人的调查显示良好的满意度与中度镇静19，但最近的数据显示，采用全身麻醉20高诊断率。 </li><li>或者，?...

Substernal goiter was first described in 1749 by Haller23. The reported incidence of substernal or mediastinal goiter varies between 0.2% and 45% of all goiters, depending on the definition used24. More than ten definitions of substernal goiter have been proposed. By the simple clinical definition, a part of the substernal thyroid remains permanently retrosternal on physical exam without neck in hyperextension, as opposed to with neck in hyperextension as per Torre&#8217;s definition25. K...

胸骨后甲状腺肿（STG）是生长缓慢的肿瘤，最终导致症状的病例中70％-80％。按照文献综述，STG的2.5-22.6％之间可有恶变2。气管，食管，喉返神经和上腔静脉的压迫常常会导致像呼吸困难，喘鸣，咳嗽，吞咽困难，发音困难，声带麻痹，Horner氏综合征，上腔静脉综合征，脑水肿症状。也有报道显性甲亢偶然的情况下。一项回顾性研究由Shin 等人报道了甲状腺的大小和呼吸急促的存在，梅核气的感觉，和3甲亢症状之间存在正相关关系。这项研究，但没有发现甲状腺肿大尺寸和吞咽困难的存在，局部不适，改变声音，咯血，或甲状腺功能减退的症状之间的相互关系。无论胸骨后及颈部甲状腺肿进行类似恶性肿瘤的风险。 HoweveR，胸骨位置，使活检诊断和治疗STG非常具有挑战性的。大多数情况下，最终需要手术切除纵隔镜使用或胸骨。 支气管内超声（EBUS）最早是在1992年由Hurter和Hanrath 4所示 。多年来，EBUS-TBNA成为了选择用于诊断非小细胞肺癌和分期的方法。报告的敏感性，特异性和阳性预测值EBUS-TBNA对纵隔及肺门淋巴结肿大为94％，100％和100％分别有并发症发生率低使得它非常安全，有效，优于传统的滨海新区5。然而，常规和EBUS引导新区被发现有统计学上相似的结果为隆突淋巴结6。 两种类型的EBUS探针已经开发到目前为止 - 径​​向探头（RP-EBUS）和曲线形探针（CP-EBUS）。 RP-EBUS是第一个成为1999年商用它拥有水充气的气球提示里面薄薄的超声探头。探头转动一角度360°垂直于插入轴线的方向。膨胀的气球提供了一个圆形接触的探针，从而使其能够获取周围气道的360°视图。它是用于评价外周位于病变7,8的中央气道的气道浸润的评估，并获得活检。后病灶局限，径向探头必须取出引导鞘在支气管镜的工作通道让路活检工具。因此，一个实时超声引导的活检不能进行。三个不同的径向探测当前可用 - 20 MHz和30 MHz的微型探针，以及20 MHz的超微型探头。微型探针可以通过支气管镜在280毫米的工作通道插入，到达子断片的气道;更高的频率探头提供更好的图像清晰度olution 9。为1.4毫米的外径，所述的超微型探头适合的小支气管镜2毫米的工作通道，并到达多个外围病变。 CP-EBUS于2005年引入的是一个7.5兆赫凸探针生理盐水膨胀气囊，在支气管镜的前端内侧（ 图1）。支气管镜管的外径为6.3毫米，且尖端的为6.9毫米。工作通道的内径为2.2毫米。范围看起来在一个35°向前倾斜角，用图的80°（ 图2）的角度。凸探头本身产生一个50°的图像，并且扫描平行于插入轴线。超声图像可以通过使用前向屈曲，或通过附加膨胀球囊用生理盐水直接将探头在支气管壁而得到。水比超声波的空气更好的导体，并且提高了图像质量。沃什丘拉尔结构可以从使用​​彩色多普勒模式扫描组织区别开来。使用专用的22或21g的新区针与回声-凹形前端（ 图3），其散发出来，在20°至支气管镜的长轴的角度进行活检。针具有40毫米的最大挤压行程，以用于停止它为20mm，以防止过度的突出部的安全机构。在针的内部导线最小化样品污染，而针穿过支气管壁。它也可用于清理针后，已通过支气管壁并进入靶疾患通过。的愿望“通过”的最佳数目据说是3-7令人满意的样品，但最高产量是从第一遍10,11。的图像中的专用超声处理器处理。这两种超声波和白光支气管镜图像在监视器上同时可见，允许EASY导航到疑似病变的部位。 CP-EBUS具有中度的镇静或全身麻醉进行实时新区直接超声引导的能力。该过程可以在门诊进行，消除了外科手术相关的发病率和需要住院手续。 为胸骨后甲状腺的诊断使用EBUS-滨海新区是新的，据报道，在只有少数病例报告12-18。根据目前的文献回顾，本文试图阐述的程序要求，并提出EBUS-TBNA的方式为胸骨后甲状腺活检。请注意，上面的设备的描述更具体奥林巴斯公司还有其他可商购的产品，以及，和较小的变化是存在的。

<table border="0" cellpadding="0" cellspacing="0" width="443">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:443px;">7.5-MHz Convex Probe-EBUS bronchoscope</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Dedicated 22-gauge or 21-gauge TBNA needle</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Ultrasound processor unit</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">On-site cytopathology (optional)</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Moderate sedation drugs - Benzodiazepines or fentanyl&#160;</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Deep sedation / General anesthesia drugs - Propofol or Remifentanil</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Local anesthesia (for airways) - 1% or 2% Lidocaine</td>
		</tr>
	</tbody>
</table>

substernal thyroid biopsy using endobronchial ultrasound-guided transbronchial needle aspiration

胸骨后甲状腺肿（STG），约占5.8％的纵隔病变1。有在由于缺乏对STG的一个统一的定义已发布的发生率有很大不同。活检通常需要区分恶性病变是良性的。与颈椎甲状腺，上覆胸骨排除STG超声引导下经皮细针穿刺。因此，外科纵隔镜是在大多数情况下进行的，从而导致显著过程相关的发病率和成本的医疗服务。支气管内超声引导下经支气管针吸活检（EBUS-TBNA）是一种常用的方法进行诊断的非小细胞肺癌（NSCLC）和分期。可以使用EBUS实时超声引导下进行微创活检为邻近于气道病变。其安全性和功效是公认的具有超过90％的灵敏度和特异性。执行EBUS作为能力与同一天排放的门诊手术具有明显的发病率和资金优势的手术。当执行EBUS医师获得程序的专门知识，他们试图分散其中的非淋巴结胸椎病状的诊断作用。我们在这里提出的EBUS-TBNA作用于胸骨后甲状腺病变的诊断，随着一步一步的协议的过程。

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) biopsy of substernal thyroid has been reported in eight case reports as per literature review12-18. The first case of substernal thyroid biopsy using Endobronchial Ultrasound was reported by Rosario et al. in 200612, wherein a CT chest done for metastatic work-up of prostate adenocarcinoma showed mediastinal lymphadenopathies. EBUS-TBNA of the lesion revealed a previously undiagnosed papillary thyroid carcinoma met...

Watch this Scientific Journal Video about Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration at JoVE.com

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

胸骨后甲状腺活检使用支气管内超声引导下经支气管针吸

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the ...

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