Competition for EUS (a) EBUS-TBNA (b) video assisted thoracoscopy

Utility and diagnostic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration cytology of mediastinal lesions: Saudi Arabian experience

Objective:

The objective of this study is to evaluate the cytological accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) of the mediastinal mass/nodular lesions.

Study Design:

Over 3½ years from inception at King Khalid University Hospital, a retrospective analysis of the cytological diagnoses of all the EBUS-TFNA procedures performed in 80 patients who had mediastinal mass/nodular enlargement. Cytology results were reviewed and correlated with the histologic follow-up.

Results:

Of the 80 patients who underwent EBUS-TFNA, 15 cases (18.75%) were positive for malignancy, 48 cases (60%) negative for malignancy and 17 cases (21.25%) unsatisfactory. Of the 48 cases, which were negative for malignancy, 24 (50%) cases were of granulomatous inflammation. The overall diagnostic yield of our EBUS-TFNA specimen was 78.75%. Forty-seven cases (58.75%) of 80 cases had histological follow-up biopsies. Among them, 32 cases (68%) had the same cytological and histological diagnosis and 15 cases (31.09%) had discordance between the cytology and the follow-up histological diagnosis. The sensitivity, specificity, and positive and negative predictive values for diagnosing granulomas by EBUS-TFNA are 77%, 82%, 83%, and 75% and for diagnosing malignancy are 71%, 100%, 100%, and 82%, respectively.

Conclusion:

Preliminary results show that cytological samples obtained through EBUS-TFNA are accurate and specific in making a diagnosis of the mediastinal mass/nodular lesions. Its optimum use depends on the effective collaboration between the cytotechnologist, pathologist, and the bronchoscopist.

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the management of mediastinal and hilar lymphadenopathy without intrapulmonary mass: experience from the largest cancer center of southern China

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for lung cancer diagnosis and lymph node staging. The purpose of this study was to investigate EBUS-TBNA for managing mediastinal and hilar lymphadenopathies without intrapulmonary masses. We retrospectively reviewed our EBUS-TBNA database that was obtained between August 2010 and October 2012. Mediastinal and hilar lymphadenopathies of unknown origin and in the absence of known pulmonary malignancies were included. Final diagnoses were determined by EBUS-TBNA, surgery, and/or clinical follow-up for at least 6 months. Sensitivity, specificity, accuracy, and positive and negative predictive values were determined using standard statistical methods. We identified 128 patients with mediastinal and hilar lymphadenopathies and without intrapulmonary masses. EBUS-TBNA was successfully performed to obtain samples from 161 lymph nodes and mediastinal masses. EBUS-TBNA was diagnostic for 119 of 128 patients (93.0%) for all disease categories. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of EBUS-TBNA were 89.8, 100, 100, 81.6, and 93.0%, respectively. The procedures were uneventful and there were no severe complications. EBUS-TBNA is a safe, minimally invasive approach for diagnosing mediastinal and hilar lymphadenopathies without intrapulmonary masses. It obviates the need for more invasive procedures for tissue sampling of the mediastinum and hilum.

Cytology of endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective study with histology correlation

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.

Endoscopic ultrasound-guided fine-needle aspiration when combined with positron emission tomography improves specificity and overall diagnostic accuracy in unexplained mediastinal lymphadenopathy and staging of non-small-cell lung cancer

BACKGROUND

The aim of this study was to assess the incremental value of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) to positron emission tomography (PET) in the diagnosis of unexplained mediastinal lymphadenopathy and staging of non-small-cell lung cancer (NSCLC).

METHODS

Patients who had both EUS-guided FNA and PET were retrospectively identified from an EUS database at a tertiary hospital. All EUS-guided FNA were carried out by one endoscopist between August 2002 and April 2005, either for the diagnosis of unexplained mediastinal lymphadenopathy or for the staging of NSCLC. Results of PET and EUS were compared with histology. A true histological positive result was defined as histological involvement in either surgery (mediastinoscopy or resection) or EUS-guided FNA. A true histological negative result was defined as negative involvement at surgery (mediastinoscopy or resection).

RESULTS

Forty-nine patients who had both PET scanning and EUS-guided FNA for diagnosis of unexplained mediastinal lymphadenopathy or staging of NSCLC were identified. Of these, 33 (73% males, n = 24, age range = 44-78 years, mean = 62 years) had surgical confirmation of mediastinal lymph node pathology. In these patients, PET alone showed sensitivity, 95%; specificity, 90%; positive predictive value, 87%; negative predictive value, 90% and accuracy, 88%; whereas the addition of EUS-guided FNA increased the overall specificity and positive predictive value to 100%, with an overall accuracy of 97%.

CONCLUSIONS

This study suggests that EUS-guided FNA complements PET by improving the overall specificity and thereby the accuracy for diagnosis of unexplained mediastinal lymphadenopathy. It provides a minimally invasive technique to assess the mediastinum in patients with NSCLC and is particularly valuable in cases in which PET findings are equivocal.