EBUS-TBNA in PET-positive lymphadenopathies in treated cancer patients

Abstract

Mediastinal lymph node enlargement is common in the follow-up of patients with previously treated malignancies. The aim of this study is to assess the role of endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) for cyto-histological evaluation of positron emission tomography with 18fluorodeoxyglucose (PET) positive mediastinal and hilar lymph nodes developed in patients with previous malignancies.All EBUS-TBNA cases performed from January 2012 to May 2016 were retrospective reviewed. Results of EBUS-TBNA in patients with mediastinal and/or hilar lymphadenopathies were analysed. Non-malignant cytopathologies were confirmed with surgical procedures or clinical and radiological follow-up.Among 1780 patients, 176 were included in the analysis. 103 of these (58.5%) had a diagnosis of tumour recurrence whereas 73 (41.5%) had a different diagnosis: 63 (35.8%) had a non-neoplastic diagnosis and 8 patients (4.6%) had a different cell type malignancy. Samples were false-negative in 5 (2.8%) out of 176 patients. The overall sensitivity, specificity, negative predicted value and diagnostic accuracy were 95.7% (95% CI 90.2–98.6%), 100% (95% CI 94.0–100%), 92.3% (95% CI 83.2–96.7%) and 97.2% (95% CI 93.5–98.8%), respectively.EBUS-TBNA demonstrated a pathological diagnosis different from the previous tumour in a large percentage of patients, confirming its strategic role in the management of patients with previously treated malignancies.

Cytologic Evaluation of Positron Emission Tomography-Computed Tomography–Positive Lymph Nodes Sampled by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Experience at a Large Cancer Center

“…Anthracosis has been reported to be another cause of false positivity on PET-CT, 9,18 and approximately 9% of PET-CTþ/ CytoÀ lymph nodes in our study had anthracotic pigmentladen macrophages described in the cytology report. We did not find any difference in the SUVs between aspirates containing lymphoid tissue with anthracotic pigment-laden macrophages versus just lymphoid tissue.…”

“…5,6 Several studies have demonstrated the effectiveness of EBUS-TBNA for invasive nodal staging of lung cancer, for tissue sampling for mediastinal and lung tumors, and for the diagnosis of lymphoproliferative disorders. 2,[7][8][9][10] However, studies correlating EBUS-TBNA cytology with PET-CT findings are limited and are often small collections of cases. In this study, we compared the cytologic and clinical findings of PET-CTpositive/cytologically malignant (PET-CTþ/Cytoþ) versus PET-CT-positive/cytologically benign (PET-CTþ/CytoÀ) lymph nodes sampled by EBUS-TBNA in a large series of patients at a cancer center.…”

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study

“…Evaluation of MHLE and mediastinal masses in patient with known/suspected EPMs constitutes ~10%‐16% of all indications for which patients undergo EBUS‐TBNA . Metastases are identified in only 40%‐50% of these patients, of whom 5%‐23% patients are found to harbour a second primary malignancy, most commonly in the lung . A significant proportion (9%‐20%) have granulomatous diseases, further characterised as TB (2%‐9%) or sarcoidosis in few studies .…”

“…False‐negative EBUS‐TBNA results are not uncommon. In previous studies, patients with a negative EBUS‐TBNA result (reactive/granulomatous/inadequate) underwent mediastinoscopy/additional surgical biopsies or were kept on radiological follow‐up for 6‐18 months to look for progressive lymph node enlargement . Malignancy was eventually detected in 9‐27% of these patients and the NPV of EBUS‐TBNA for malignancy ranged from 73% to 92% .…”

“…Role of EBUS‐TBNA in sampling mediastinal lymph nodes and masses in patients with EPMs has been evaluated in a few clinical studies previously, with variable sensitivities (81%‐95%) and negative predictive values (73%‐92%) reported . We performed a retrospective review of all EBUS‐TBNA‐guided aspirates received in our department from patients with suspected, newly diagnosed or previous history of EPMs.…”