title: Substernal thyroid biopsy using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration.
abstract: Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions(1). There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, State University of New York, Buffalo; medshek@gmail.com.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Division of Pulmonary and Critical Care Medicine, State University of New York, Buffalo.
authors.forename: Arjun
authors.initials: A
authors.lastname: Mohan
authors.affiliation: Interventional Pulmonology Section, Division of Medicine, Roswell Park Cancer Institute, State University of New York, Buffalo.
authors.forename: Samjot S
authors.initials: SS
authors.lastname: Dhillon
authors.affiliation: Interventional Pulmonology Section, Division of Medicine, Roswell Park Cancer Institute, State University of New York, Buffalo.
authors.forename: Kassem
authors.initials: K
authors.lastname: Harris
mesh_terms: D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation / Q000379:methods*; D006045:Goiter, Substernal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D012680:Sensitivity and Specificity; D013959:Thyroid Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology