Use of Ancillary Techniques in Improving the Yield of Samples Obtained at Endoscopic Ultrasound-Guided Fine Needle Aspiration of Thoracic and Abdominal Lymph Nodes

Abstract

Objectives: Thoracic and abdominal lymph nodes may be enlarged in a variety of disorders. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established technique for sampling such nodes, but samples obtained are small, which may make definitive diagnosis difficult. We conducted a retrospective review to determine the contribution of ancillary techniques, such as special histochemistry (SHC), immunohistochemistry (IHC) and flow cytometry, in increasing the diagnostic yield of EUS-FNA carried out at our institution. Study Design: Between November 2005 and December 2012, 278 patients underwent EUS-FNA of enlarged thoracic and abdominal nodes at our institution. All specimens obtained were subjected to rapid on-site evaluation. Data were reviewed in all patients requiring ancillary techniques for definitive diagnosis. Results: Ancillary techniques were performed in 111 of 278 cases. IHC was performed in 24, flow cytometry in 3 and SHC staining in 84. IHC and SHC aided in reaching a definitive diagnosis in 19 of 24 and 3 cases, respectively. Flow cytometry led to a definitive diagnosis in 3 cases. A total of 80 cases were also submitted to culture for tuberculosis with 6 positive for Mycobacterium tuberculosis. Conclusions: Ancillary studies in EUS-FNA of thoracic and abdominal lymph nodes can significantly improve the yield of EUS-FNA.

Onsite cytopathology evaluation and ancillary studies beneficial in EUS‐FNA of pancreatic, mediastinal, intra‐abdominal, and submucosal lesions

“…Malignant lymphoma is broadly categorized into HL and NHL. Flow cytometry is a useful adjunct, in addition to IHC stains, in the subcategorization of NHL . Hence, all cases in which NHL is suspected on EUS‐FNA ought also to have flow cytometry.…”

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version)

“…For most indications, cytopathological and histopathological assessment should be used in a complementary manner rather than exclusively. Cytopathological methods perform better for the evaluation of nuclear and cellular characteristics, while histopathological assessment of CB and core samples are advantageous over cytopathological assessment in cases in which immunohistochemistry is able to establish a diagnosis, e. g. in non-PDAC, gastrointestinal SETs, rare benign diseases, and lymphadenopathy [94,148,216,221,281,283,290,310,332,340,354,356,361,369,372,650].…”

Endoscopic/Endobronchial Ultrasound-Guided Fine Needle Aspiration and Ancillary Techniques, Particularly Flow Cytometry, in Diagnosing Deep-Seated Lymphomas

“…EUS- or EBUS-FNA has been demonstrated to be an accurate tool for the cytological diagnosis of deep-seated lesions of unknown origin, especially metastatic epithelial malignancies [13,21,22,23,24]. However, FNA diagnosis of deep-seated lymphoma remains controversial [6,25,26].…”