Substernal thyroid biopsy using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

J Vis Exp. 2014 Nov 10;(93):e51867. doi: 10.3791/51867.


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.

Publication types

  • Video-Audio Media

MeSH terms

  • Bronchoscopy / instrumentation
  • Bronchoscopy / methods
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / instrumentation
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods*
  • Goiter, Substernal / diagnosis*
  • Goiter, Substernal / diagnostic imaging
  • Goiter, Substernal / pathology
  • Humans
  • Sensitivity and Specificity
  • Thyroid Diseases / diagnosis
  • Thyroid Diseases / diagnostic imaging
  • Thyroid Diseases / pathology