A Practical Alternative Approach to Rapid Cytological Analysis for Endobronchial UltrasoundGuided Transbronchial Needle Aspiration: A Retrospective Study with Cytologic-Histologic Correlation

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Lab Invest

Abstract

Background: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure for evaluating lung nodules and lymph nodes. The reported sensitivity and specificity of EBUS-TBNA with rapid on-site evaluation (ROSE) are variable at 85-90% and 90-95%, respectively. We employed a method for performing EBUS without ROSE at our institution with staffing and cost benefit. We're a tertiary care center with a main campus and peripheral sites. The aim of this study is to compare the diagnostic value of our EBUS-TBNA without ROSE method with the reported values of EBUS-TBNA with ROSE in the literature. Design: Cells were collected by pulmonologists; all passes were put in Saccomanno preserve and sent to Cytology lab. The cells were then drained through tissue bag to collect tissue fragments for making cell blocks. The liquid portion was used for making ThinPrep slide. All consecutive EBUS cases, including FNA of the lung nodules, mediastinal masses, and lymph nodes between 5/2022-4/2023 at our institution (main campus) were included. Pathological findings were collected from our pathology archives. Clinical information was collected from medical records. Results: In the study period, 1804 EBUS cases from 602 patients were identified, including 362 lung/ mediastinal masses, 1441 lymph nodes, and 1 of both. Out of the 1443 lymph nodes biopsied, lymph nodes were from cervical (3), station 1 (4), station 2 (12), station 4 (437), station 5 (1), station 6 (1), station 7 (413), station 8 (2), station 10 (12), station 11 (556), and station 12 (2). Additionally, there were 28 hilar masses and 4 mediastinal masses biopsied; the rest were lung nodules. Cytology diagnosis were non-diagnostic in 203 (11.3%), benign (1124, 62.3%), atypical (65, 3.6%), suspicious (12, 0.7%), and positive (399, 22.1%). The sensitivity and specificity of our method (EBUS without ROSE) were 90.8% and 97%, respectively. Molecular and PDL-1 were ordered on 18% positive cyto cases, all adequate. In addition, molecular and PDL-1 were ordered on surgical specimens with concurrent positive cytology (13.7%). Conclusions: EBUS without ROSE method at our institution (all passes deposited in preserve, drained with tissue bag, tissue fragments collected for cell block, supernatant collected for ThinPrep) provided sufficient adequacy for ancillary testing and rendering diagnosis, with excellent sensitivity and specificity. This method also provided excellent tumor cellularity for molecular and PDL-1 testing.

Volume

104

Issue

3

First Page

S487

Last Page

S488

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