Inflammatory and neoplastic processes of the lung: Differential diagnosis and pitfalls in FNA biopsies

Silverman, Jan F.

doi:10.1002/dc.2840130514

Cited by 36 publications

(41 citation statements)

References 52 publications

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“…7,28 Patients with infectious disease or sarcoidosis may present with mediastinal and pulmonary lymphadenopathy. 29 In our study, 16 cases were diagnosed as granulomatous inflammation by cytology and an additional 4 cases were diagnosed by histology. Mycobacterial and fungal cultures were submitted based on clinical suspicion and immediate on-site assessment, and the results were negative.…”

Section: Adenocarcinoma (Nos¼1) Suspicious For Bac (N¼1)mentioning

confidence: 72%

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

Feller‐Kopman

Yung

Burroughs

et al. 2009

Cancer Cytopathology

103

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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.

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Section: Adenocarcinoma (Nos¼1) Suspicious For Bac (N¼1)mentioning

confidence: 72%

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

Feller‐Kopman

Yung

Burroughs

et al. 2009

Cancer Cytopathology

103

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“…6 Sometimes benign and malignant lesions cannot be discriminated by morphology with certainty, and reactive changes of bronchial and alveolar epithelium, air-drying artifacts during smear preparation, and poorly preserved specimens sometimes impede or even render a distinct cytological diagnosis impossible. [7][8][9][10] Accordingly, cytology sometimes leaves an equivocal (2.9% of cases in a single institution; 8.6% from a single hospital during a 9-month period in our institution) or inconclusive result even in the hands of experienced observers. 5,11,12 To prevent repeated diagnostic efforts and potentially harmful invasive diagnostic procedures, it is essential to enhance diagnostic accuracy in these cases.…”

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confidence: 69%

Equivocal cytology in lung cancer diagnosis

Schramm

Wrobel

Born

et al. 2011

Cancer Cytopathology

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BACKGROUND:Sometimes, cytological lung cancer diagnosis is challenging because equivocal diagnoses are common. To enhance diagnostic accuracy, fluorescent in situ hybridization (FISH), DNA‐image cytometry, and quantitative promoter hypermethylation analysis have been proposed as adjuncts.METHODS:Bronchial washings and/or brushings or transbronchial fine‐needle aspiration biopsies were prospectively collected from patients who were clinically suspected of having lung carcinoma. After routine cytological diagnosis, 70 consecutive specimens, each cytologically diagnosed as negative, equivocal, or positive for cancer cells, were investigated with adjuvant methods. Suspicious areas on the smears were restained with the LAVysion multicolor FISH probe set (Abbott Molecular, Des Plaines, Illinois) or according to the Feulgen Staining Method for DNA‐image cytometry analysis. DNA was extracted from residual liquid material, and frequencies of aberrant methylation of APC, p16INK4A, and RASSF1A gene promoters were determined with quantitative methylation‐specific polymerase chain reaction (QMSP) after bisulfite conversion. Clinical and histological follow‐up according to a reference standard, defined in advance, were available for 198 of 210 patients.RESULTS:In the whole cohort, cytology, FISH, DNA‐image cytometry, and QMSP achieved sensitivities of 83.7%, 78%, 79%, and 49.6%, respectively (specificities of 69.8%, 98.2%, 98.2%, and 98.4%, respectively). Subsequent to cytologically equivocal diagnoses, FISH, DNA‐image cytometry, and QMSP definitely identified malignancy in 79%, 83%, and 49%, respectively. With QMSP, 4 of 22 cancer patients with cytologically negative diagnoses were correctly identified.CONCLUSIONS:Thus, adjuvant FISH or DNA‐image cytometry in cytologically equivocal diagnoses improves diagnostic accuracy at comparable rates. Adjuvant QMSP in cytologically negative cases with persistent suspicion of lung cancer would enhance sensitivity. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.

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“…Cells with intact cytoplasm often exhibit a plasmacytoid appearance. 15,16,26,27 Aspirate material from this lung mass shared some of these characteristics. However, the smears showed low cellularity, no plexiform vascularity, and no cells with typical saltand-pepper chromatin or plasmacytoid morphology.…”

Section: Carcinoid Versus Reactive Pneumocytes Casementioning

confidence: 84%

“…An example of squamous cell carcinoma obtained from a bronchial washing is demonstrated in Figure 3. Cytologic features distinguishing squamous cell carcinoma from reactive squamous atypia 7,15,16 are summarized in Table 1. The patient in Case 2 also proved to have an Aspergillus infection; however, the long smoking history and mass lesion in the lung were much more suspicious than the findings in the patient in Case 1 for a primary lung carcinoma.…”

Section: Casementioning

confidence: 99%

“…The majority of the atypical cells demonstrated features more consistent with either mesothelial cells or epithelioid histiocytes than NSCLC. The cytologic features distinguishing these cells from squamous cell carcinoma 7,15,16 are summarized in Table 1. One finding in this aspirate that was very worrisome was the amount of necrosis and granular material, features often observed in cavitating keratinizing squamous cell carcinoma.…”

Section: Casementioning

confidence: 99%

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