CT-Guided TTNB Biopsy vs. EBUS

Posted by bpb @bpb, Aug 16 10:07pm

I have a upper left lobe "hot" nodule that had a failed CT-Guided TTNP biopsy but would go to another provider for this type of biopsy to ensure a successful tissue sample. Another provider recommended an EBUS biopsy – I have read NIH papers on both and am now second-guessing myself as the location is tricky either way. Any advice or suggestions? How do I find unbiased advice? Both facilities & providers have a financial interest in seeing me use their services. One is Interventional Radiology and the other Interventional Pulmonology.

Beth

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@bpb, that is a tough decision, especially when concerned about the providers' financial interest. I know that you have read NIH papers about each, but for the sake of other members and a single source, I offer these plain language descriptions of each procedure from the American Lung Association

EBUS (endobronchial ultrasound) bronchoscopy https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/endobronchial-ultrasound-ebus

CT-guided transthoracic needle biopsy (TTNB) https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/ct-scan-guided-lung-biopsy

In my non-medical thought process, might it be best to get an EBUS since the TTNB failed? Might you have an option to go to a major medical facility like Mayo Clinic where the financial interest is not an issue since either procedure would be done at the same facility?

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@colleenyoung

@bpb, that is a tough decision, especially when concerned about the providers' financial interest. I know that you have read NIH papers about each, but for the sake of other members and a single source, I offer these plain language descriptions of each procedure from the American Lung Association

EBUS (endobronchial ultrasound) bronchoscopy https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/endobronchial-ultrasound-ebus

CT-guided transthoracic needle biopsy (TTNB) https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/ct-scan-guided-lung-biopsy

In my non-medical thought process, might it be best to get an EBUS since the TTNB failed? Might you have an option to go to a major medical facility like Mayo Clinic where the financial interest is not an issue since either procedure would be done at the same facility?

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Hi Colleen,

Thanks for your thoughtful reply. I am going to go with the EBUS as yes, it will be at a top West Coast teaching hospital. If this one fails, I'll consider another CT-guided TNNB. I also talked with my primary who, honestly, was not very helpful. She couldn't understand my anxieties and questions and made light of my concerns.

The American Lung Association's explanations are good. That was one of the first places I turned to when the nodule was discovered. There is actually a second one but only the one being biopsied showed as "hot" on the PET scan.

This focus on health care with patients as consumers is not helpful to any one in the "hot" seat having to make decisions for herself. I so wish there was a way to have an expert & timely unbiased evaluation that would give insightful advice. Rather it feels like every one wants you to go to their facility & have their specialty's go-to procedure.

Maybe I just am needing to vent a little as a way to relieve the anxiety I'm feeling since these nodules were found in mid-June. It feels like I should have had a diagnosis in this time.

Thanks for listening and for your response.

BPB

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I am sorry you are going through this. I had lower left lobe nodule to figure out, so i know the level of anxiety is very high.
I think its pulmonologist who should have made the call to do ebus first time around !
The more health care professionals you get to talk virtually or in person who have access to your scans, the better.
Going with ebus makes sense if ct guided didnt get unless interventional radiologist wasnt experienced enough. It is hard to make the call, so i think finding the right pulmonologist who you trust.
Good luck and hopefully when this all is over you will have time to look for new pcp as yours obviously doesnt have empathy

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@lenchiksf

I am sorry you are going through this. I had lower left lobe nodule to figure out, so i know the level of anxiety is very high.
I think its pulmonologist who should have made the call to do ebus first time around !
The more health care professionals you get to talk virtually or in person who have access to your scans, the better.
Going with ebus makes sense if ct guided didnt get unless interventional radiologist wasnt experienced enough. It is hard to make the call, so i think finding the right pulmonologist who you trust.
Good luck and hopefully when this all is over you will have time to look for new pcp as yours obviously doesnt have empathy

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Hi Lenchiksf,

Thank you for your kind and empathic response. I really like hearing from someone else who's going through it or has been there. It helps a lot.

I got more info today from the interventional pulmonologist's office – it will be a CBCT navigational bronchoscopy with or without EBUS. The CB stands for cone beam. While it sounds very sci-fi and advanced (and a really really long name), the first thing I thought of was the Conehead family on SNL. I imagined being in the surgery suite and seeing everyone as a Conehead. This really helped my anxiety, both to know more information and to find something funny, amusing and non-threatening about it all.

The first time I was scheduled for a biopsy, it was for a navigational bronchoscopy & less than 24 hours before the procedure, insurance informed me they denied it. I figured they would have to do a second one because the CT-guided one at the local hospital didn't yield what was needed. The other good news today is that it's been approved by insurance.

Thank you everyone, I am so grateful for your compassion.

BPB
I think I am extra sensitive to everything these days.

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Yes its pretty intense not knowing whats going on.

I just had HRCT (high resolution CT) last month to look for air trapping, but i read it also helps to distinguish between benign and malignant and i thought to myself maybe i didnt have to go through whole IR lung biopsy was somewhat unpleasant, you feel like you are suffocating and can only take very shallow tiny breaths
You can ask your doctors if HRCT an option for you at this time

One day at a time, try to do something that takes your mind off!

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Hello Everyone:

An update. I had my biopsy procedure (CBCT navigational bronchoscopy wiht or without EBUS) this last week & I have some news to share. The nodules are lung cancer. The lymph node samples taken are clear. I'm going to keep an eye on this group as I also have asthma and so many sensitivities, I joke that I should be a bubble woman. If you have any ideas, thoughts, wisdom on what you wish you'd known or I should ask, please respond.

Your thoughtful responses the week before my biopsy helped calm a lot of fears & anxieties. I received pretty incredible care and I'm sure that experience will add to my confidence in remaining with this health care system and its excellent professionals.

In embracing the health journey,
bpb

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