Impact of needle gauge on characterization of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) histology samples

Abstract

A12 Thorax 2012;67(Suppl 2):A1-A204 Introduction Cardiopulmonary Exercise testing (CPET) has become an important tool for perioperative assessment as it may identify patients at risk of postoperative cardiopulmonary complications. Older (1) recommended that an Anaerobic Threshold (AT)<11 or >11ml/min/kg can be used to stratify post-operative treatment in colorectal patients (ITU, HDU or ward). The BTS guidelines (2) recommend that a Peak VO2 (PVO2)<15 or >15ml/ min/kg can be used as a risk assessment in thoracic surgical patients. However, CPET can be difficulty to carry out. This study was undertaken to determine whether selected lung function values correlated with CPET outcome, so that they could be used as an alternative to AT and PVO2. Method 500 pre-operative colorectal (388) and oesophageal (112) patients attending the Lung Function Department were analysed. Spirometry and Gas Transfer were performed to assess lung function. CPET was performed on a cycle ergometer to calculate PVO2 and AT. Results The area under the curve (AUC) of a Receiver Operating Curve (ROC) analysis was carried out on the 500 patients. This compared percent predicted FEV1, FVC, TLco and Kco values to PVO2 and AT. Abstract S21 Table 1 AUC FEV1 (% Predicted) FVC (% Predicted) TLco (% Predicted) Kco (% Predicted) PVO2 AT PVO2 0.560 0.557 0.721 0.625 1.00 0.894 AT 0.547 0.568 0.643 0.555 0.877 1.000 Discussion Our findings indicated that analysis of lung function variables cannot reliably predict PVO2 or AT outcome. However, of the variables recorded, TLco was the best marker for predicting a PVO2>15ml/min/kg (0.721). When the cutoff for TLco was set at 80% predicted it had a sensitivity and 1-specificity of 62% and 24% respectively. Interestingly, there was a significant correlation between AT and PVO2 (0.894), suggesting that AT can be used as a predictor of PVO2. If the cutoff for AT was set at 11ml/min/kg; the sensitivity was 91.7% and the 1-specificity 37.7%. However if the cutoff was adjusted to 12ml/min/kg; the sensitivity was 77.3% and the 1-specificity was 13.7%. Conclusion These results suggest that in pre-operative assessment of patients undergoing thoracic surgery, an AT>12ml/min/kg could be used as an alternative measure if the patient was unable to achieve a PVO2>15ml/min/kg. Reference 1. Older(1999). Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest; 116; 355-62. 2. BTS Guidelines on the selection of patients with lung cancer for surgery (2001). Thorax 56:89-108.

Adequacy of endobronchial ultrasound-guided transbronchial needle aspiration samples processed as histopathological samples for genetic mutation analysis in lung adenocarcinoma

“…Contrary to published data on malignancy phenotyping (27), both needle gauges (22G and 21G) achieved high success rates for EGFR mutation testing without significant differences, although the study may have been underpowered to show this, also considering the 98.75% success rate. The only sample insufficient for EGFR mutation analysis was obtained using a 21G needle.…”

“…In our institution, the preferred method of analysis of EBUS-TBNA samples is processing using histopathological techniques (27). However, the majority of previous studies have used cell blocks or needle washings for cytopathological analysis.…”

“…EBUS-TBNA was performed as previously described, under light conscious sedation with midazolam and fentanyl using a convex probe ultrasound bronchoscope (Olympus BF-UC260FW; Olympus Corp., Tokyo, Japan) (26,27). The procedures were performed by three trained operators (ARLM, AJ and MJP).…”

An Unusual Mediastinal Mass

“…5 EBUS-TBNA has a high sensitivity and negative predictive value for malignancy in the mediastinal lymph nodes, with quoted sensitivities of between 93-97% and negative predictive values of between 89-97% in recent publications. 1,5,6 There is a paucity of published data relating to EBUS-TBNA in thyroid lesions, but one case series of 12 patients demonstrated EBUS-TBNA correctly detected three malignant cases and was correctly negative in the remaining nine benign cases confirmed on follow-up or further biopsy. 7 In euthyroid, asymptomatic patients, regular follow-up is advised given the risk (albeit low) of malignant transformation.…”

Linear probe 19-gauge endobronchial ultrasound diagnosis of a benign chondroid hamartoma

“…Two previous cases of pulmonary hamartoma diagnosed with EBUS-TBNA have been reported in the literature using a smaller 22G needle where the findings were suggestive [5,6], however this is the first reported case of linear probe EBUS-TBNA using a 19G needle to diagnose a chondroid hamartoma and with greater confidence from the histological findings. Some published studies have already suggested that using a larger gauge needle at EBUS-TBNA can improve diagnostic rates, particularly in benign disease [7]. Otherwise, cases of chondroid hamartoma usually require either more invasive transbronchial biopsy or surgical biopsy.…”