Clinical Usefulness of Fungal Culture of EBUS-TBNA Needle Rinse Fluid and Core Tissue

Abstract

The diagnosis of pulmonary fungal infections is challenging due to the difficulty of obtaining sufficient specimens. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needle rinse fluid has become an emerging diagnostic material. This study evaluated the role of routine fungal culture from EBUS-TBNA needle rinse fluid, in addition to histopathologic examination and fungal culture of EBUS-TBNA core tissue, in the diagnosis of pulmonary fungal infections. Materials and Methods: Among patients who underwent EBUS-TBNA, those with results for at least one of three tests (histopathologic examination, fungal culture of EBUS-TBNA core tissue or needle rinse fluid) were included. Patients with a positive test were divided into two groups (clinical fungal infection and suspected fungal contamination) according to their clinical assessment and therapeutic response to antifungal. Results: Of 6072 patients, 41 (0.7%) had positive fungal tests and 9 (22%) were diagnosed as clinical fungal infection. Of the 5222 patients who were evaluated using a fungal culture from EBUS-TBNA needle rinse fluid, 35 (0.7%) had positive results. However, only 4 out of 35 (11.4%) were classified as clinical fungal infection. Positive results were determined in 4 of the 68 (5.9%) evaluated by a fungal culture of EBUS-TBNA core tissue, and all were diagnosed as clinical fungal infection. Conclusion: Routine fungal culture of EBUS-TBNA needle rinse fluid is not useful due to the low incidence of fungal infection and high rate of contamination. However, fungal culture of EBUS-TBNA core tissue and needle rinse fluid should be considered in patients with clinically suspected fungal infection.

A decade of change: Trends in the practice of cytopathology at a tertiary care cancer centre

“…EBUS‐TBNA is a minimally invasive procedure with high sensitivity and specificity that has been used with much success to obtain adequate tumour samples for diagnosis and for molecular testing in patients with non–small cell lung cancer (NSCLC), for which biomarker testing for predictive and prognostic markers is critical for patient management. Furthermore, EBUS‐TBNA can potentially be used as a safer and more cost‐effective tool than invasive excisional biopsy by mediastinoscopy, thoracoscopy, or thoracotomy for diagnosing and staging lymphoma and for diagnosing granulomatous and infectious disease 25‐29 . Samples obtained through EBUS procedures can be triaged at the time of the procedure and routed to microbiology for culture studies or flow cytometry for suspected haematolymphoid malignancies and/or used for special stains and immunostains, as needed.…”

Clinical utility of EBUS‐TBNA of hilar, interlobar, and lobar lymph nodes in patients with primary lung cancer

“…Once the tissue core had been secured, it was blotted in filter paper to remove excess blood, fixed in formalin, and then the tissue coagulum clot was sent for histological examination. 18 Aspirate specimens were expelled onto glass slides, smeared, immediately fixed, and sent for cytological and/or histological examination. 17 Rapid on-site cytopathological evaluation was not performed.…”