Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

Abstract

BACKGROUND:Endobronchial ultrasound (EBUS) is a relatively new modality that can be used to guide transbronchial needle aspiration (TBNA) of mediastinal and hilar lymph nodes and peripheral lung lesions. Few studies have investigated the cytological profile of EBUS‐TBNA specimens. In this study, we have reviewed the cytological profile of 135 consecutive cases, including 71 lymph node cases, 4 lung cases, and 60 cases of both lymph node and lung sampling. Our study contains the largest number of cases in the evaluation of cytomorphology.METHODS:The cytological specimens were collected using an ultrasound bronchofibervideoscope with a 22‐gauge needle and core biopsies were obtained with a 19‐gauge needle. An experienced cytotechnologist performed an immediate on‐site evaluation of adequacy. An immediate assessment was given to the clinician after each pass. In many patients, multiple sites were sampled. The average slides of each case were 9.9 (median of 12), with a range from 2 to 24.RESULTS:Of 131 cases of lymph node sampling, 45 cases (34.6%) were diagnosed as malignant, 73 cases (55.7%) as benign process, 5 cases (3.8%) as suspicious for malignancy, and 1 case (0.8%) as atypical cells. Of the 64 cases of lung lesion sampling, 21 cases (32.8%) were diagnosed as malignant, 35 cases (54.7%) as benign process, 1 case (1.5%) as suspicious for malignancy, and 4 cases (6.3%) as atypical cells. The lymph node nondiagnostic rate was 5.3%, whereas the nondiagnostic rate for lung lesions was 4.7%. Eighty‐eight cases (65.2%, 88/135) had corresponding core biopsies (with a 19‐gauge needle) or follow‐up surgery. When histology was taken as the gold standard, the sensitivity, specificity, and positive and negative predictive values for EBUS‐TBNA were 85.0%, 100%, and 100% and 89.7%, respectively. However, when both histology and clinical follow‐up were considered together, the overall sensitivity and negative predictive values were increased to 94.7% (P < .05) and 96.6% (P < .05), respectively.CONCLUSIONS:This study shows that EBUS‐TBNA is an accurate and sensitive method for diagnosing and staging lung cancer. The constant challenge that we as cytopathologists are now facing is how to improve our diagnostic ability and accuracy for lung cancer. We believe that this optimal goal can be achieved with the effective use of EBUS‐TBNA sampling and collaboration with our clinical colleagues. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

“…One group of authors reported that, of 131 cases of mediastinal lymph node sampling performed at the Johns Hopkins Hospital, 7 (5.3%) had samples that were considered inappropriate. (9) In the present study, the rate of inappropriate samples was 25%, which is similar to the rates reported in the literature for initial experiences. Contributing to that is the fact that the biopsies involved hilar lymph node stations, which had a higher rate of "inappropriate" samples when compared with the biopsies involving the subcarinal station, which is more easily accessed.…”

Cytology-based treatment decision in primary lung cancer: Is it accurate enough?

“…In a retrospective study by Feller-Kopman et al, the sensitivity, specificity, positive and negative predictive values (NPV) of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) cytology specimens from lymph nodes and lung tissue were 85.0%, 100%, 100% and 89.7%, respectively, when compared to histology. Concordant cytological and histological diagnoses were found in 64/88 (72.7%) cases, across all subtypes [31]. Sun et al reported similar results, with sensitivity, specificity, PPV and NPV of 88.9%, 96.4%, 97% and 87.1%, respectively, when EBUS-TBNA specimens of lymph nodes and peribronchial lung lesions were compared to tissue histology.…”

“…Novel diagnostic techniques are now available, providing relatively high accuracy rates [31,32]. In a retrospective study by Feller-Kopman et al, the sensitivity, specificity, positive and negative predictive values (NPV) of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) cytology specimens from lymph nodes and lung tissue were 85.0%, 100%, 100% and 89.7%, respectively, when compared to histology.…”

Biomarkers in the Accurate Subclassification of Non-Small-Cell Lung Carcinoma for Targeted Therapy: Issues and Prospects

“…Thus, transthoracic and/or transbronchial fine needle aspiration biopsy of the tumor become important approaches to obtain tumor tissue for diagnosis, staging and subclassification as well as for molecular characterization [6]. Due to the heterogeneity of lung cancer, accurate diagnosis on small biopsies can be challenging [2,3].…”