The Role of the Pulmonologist in Rapid On-site Cytologic Evaluation of Transbronchial Needle Aspiration

Bonifazi, Martina; Sediari, Michele; Ferretti, Maurizio; Poidomani, Grazia; Tramacere, Irene; Mei, Federico; Zuccatosta, Lina; Gasparini, Stefano

doi:10.1378/chest.13-0756

Cited by 70 publications

(79 citation statements)

References 15 publications

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“…Local procedures vary extensively as reflected in the available studies. A recent observational trial did provide preliminary evidence that a pulmonologist can perform, after a short yet intensive training phase, ROSE to assess the adequacy of conventional TBNA samples from hilar/mediastinal LN with accuracy similar to that of a board-certified cytopathologist [54]. …”

Section: Results Of Pico Questionmentioning

confidence: 99%

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

et al. 2014

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Rationale: Conventional transbronchial needle aspiration (TBNA) and endobronchial ultrasound (EBUS)-TBNA are widely accepted tools for the diagnosis and staging of lung cancer and the initial procedure of choice for staging. Obtaining adequate specimens is key to provide a specific histologic and molecular diagnosis of lung cancer. Objectives: To develop practice guidelines on the acquisition and preparation of conventional TBNA and EBUS-TBNA specimens for the diagnosis and molecular testing of (suspected) lung cancer. We hope to improve the global unification of procedure standards, maximize the yield and identify areas for research. Methods: Systematic electronic database searches were conducted to identify relevant studies for inclusion in the guideline [PubMed and the Cochrane Library (including the Cochrane Database of Systematic Reviews)]. Main Results: The number of needle aspirations with both conventional TBNA and EBUS-TBNA was found to impact the diagnostic yield, with at least 3 passes needed for optimal performance. Neither needle gauge nor the use of miniforceps, the use of suction or the type of sedation/anesthesia has been found to improve the diagnostic yield for lung cancer. The use of rapid on-site cytology examination does not increase the diagnostic yield. Molecular analysis (i.e. EGFR, KRAS and ALK) can be routinely performed on the majority of cytological samples obtained by EBUS-TBNA and conventional TBNA. There does not appear to be a superior method for specimen preparation (i.e. slide staining, cell blocks or core tissue). It is likely that optimal specimen preparation may vary between institutions depending on the expertise of pathology colleagues.

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Section: Results Of Pico Questionmentioning

confidence: 99%

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

et al. 2014

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“…Bonifazi et al [20] demonstrated that a pulmonologist, who has received appropriate training from a specialist pathologist, can reliably classify specimens obtained with c-TBNA from intrathoracic lymphadenopathy. They also suggested that if pulmonologists in training possess a basic knowledge of cytopathology, it could obviate most of the difficulties associated with the involvement of cytopathologists in routine diagnostic interventional pulmonology activities [20].…”

Section: Introductionmentioning

confidence: 99%

A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation

et al. 2019

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Background: The widespread use of rapid on-site evaluation is hampered by constraints related to time and resources, inadequate reimbursement, and evidence from randomized trials that show a lack of increase in diagnostic yield and specimen adequacy associated with its usage. Objective: We aimed to verify whether a pulmonologist can assess endosonography-derived lymph node samples after a comprehensive and reproducible training provided by a specialist pathologist. Methods:Prospective, observational trial structured in three phases. In the first (training) phase, a pathologist critically evaluated the smears from 150 archival endosonography cases with a pulmonologist. In the second (test) phase, the pulmonologist was asked to assess 50 archival endosonography-derived samples. In the last (real-life) phase, the pulmonologist classified the samples from 200 patients during the endosonography. The overall agreement between pulmonologist and pathologist (gold standard), assessed through κ-statistics, was the primary outcome. The agreement for the identification of specific cytological categories was the secondary outcome. Results: The overallagreement between pulmonologist and pathologist was 84% (κ0.765, 95% CI 0.732–0.826) in the test phase and 89.7% (κ 0.844, 95% CI 0.799–0.881) in the real-life phase. The agreement for specific cytological categories was 92.7% (95% CI 0.824–0.980) for inadequate samples, 90.3% (95% CI 84.5–94.5%) for reactive lymphadenopathies, 90.5% (95% CI 0.845–0.946) for malignancy, and 73% (95% CI 0.515–0.897) for granulomatous samples. Conclusions: A trained pulmonologist can reliably assess adequacy and malignancy for endosonography-derived samples, which could be useful in institutions where a cytopathologist/cytotechnician is not available regularly.

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“…In this setting rapid on-site evaluation for tumor cell adequacy is crucial to ensure that the obtained material is sufficient and properly preserved not only for the identification of malignancy but also for biomarker testing [2]. This can be successfully performed either by a cytopathologist or by a properly trained cytotechnologist or pulmonologist [3,4]. Unfortunately, due to budget and staff limitation, rapid on-site evaluation is not always feasible [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Epidermal Growth Factor Receptor Test Performed on Liquid-Based Cytology Lung Samples: Experience of an Academic Referral Center

Bellevicine

Malapelle²,

Vigliar³

et al. 2014

Acta Cytologica

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Objectives: In this study we reviewed our practice of lung cancer epidermal growth factor receptor (EGFR) mutational testing in an academic centralized laboratory setting, where direct smears and liquid-based cytology (LBC) slides represent the most frequent cytological specimens received. The aim was to assess the differences, if any, between these sample types in terms of DNA yield, adequacy rates and overall EGFR testing performance. Study Design: A total of 362 cases were retrieved - received from January 2012 to January 2014 for EGFR testing - including 204 LBC specimens and 158 smears. Exon 19 deletions and the L858R point mutation in exon 21, detected by fragment assay and TaqMan assay, respectively, were confirmed by direct sequencing or by high-resolution melting. Results: Although the direct smears showed a higher DNA yield (60.94 vs. 23.07 ng/µl) and were more frequently cell-rich (54%) than the LBC slides (31.4%), the differences in adequacy (direct smears: 97.4%; LBCs: 94.1%) and in mutant rate (direct smears: 10.3%; LBCs: 14.0%) between the two sample types did not reach statistical significance. Conclusions: Not only direct smears but also LBC slides represent an effective preparation and storage medium for cytological material to be used for EGFR molecular testing.

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The Role of the Pulmonologist in Rapid On-site Cytologic Evaluation of Transbronchial Needle Aspiration

Cited by 70 publications

References 15 publications

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

A Trained Pulmonologist Can Reliably Assess Endosonography-Derived Lymph Node Samples during Rapid On-Site Evaluation

Epidermal Growth Factor Receptor Test Performed on Liquid-Based Cytology Lung Samples: Experience of an Academic Referral Center

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