Contribution of cell blocks obtained through endobronchial ultrasound-guided transbronchial needle aspiration to the diagnosis of lung cancer

Abstract

BackgroundConventional smears of samples obtained by endobronchial ultrasound with real-time transbronchial needle aspiration (EBUS-TBNA) have proven useful in lung cancer staging, but the value of additional information from cell-block processing of EBUS-TBNA samples has only been marginally investigated. This study focussed on the contribution of cell block analysis to the diagnostic yield in lung cancer.MethodsPatients referred for lung cancer diagnosis and/or staging by means of EBUS-TBNA were enrolled, the adequacy of the obtained samples for preparing cell blocks was assessed, and the additional pathologic or genetic information provided from cell block analysis was examined.ResultsIn 270 lung cancer patients referred for EBUS-TBNA (mean age, 63.3 SD 10.4 years) 697 aspirations were performed. Cell blocks could be obtained from 334 aspirates (47.9%) and contained diagnostic material in 262 (37.6%) aspirates, providing information that was additional to conventional smears in 50 of the 189 samples with smears that were non-diagnostic, corresponding 21 of these blocks to malignant nodes, and allowing lung cancer subtyping of 4 samples. Overall, cell blocks improved the pathologic diagnosis attained with conventional smears in 54 of the 697 samples obtained with EBUS-TBNA (7.7%). Cell blocks obtained during EBUS-TBNA also made epithelial growth factor receptor mutation analysis possible in 39 of the 64 patients with TBNA samples showing metastatic adenocarcinoma (60.1%). Overall, cell blocks provided clinically significant information for 83 of the 270 patients participating in the study (30.7%).ConclusionsCell-block preparation from EBUS-TBNA samples is a simple way to provide additional information in lung cancer diagnosis. Analysis of cell blocks increases the diagnostic yield of the procedure by nearly seven per cent and allows for genetic analysis in a sixty per cent of the patients with metastatic adenocarcinoma.

Comparison of multiple techniques for endobronchial ultrasound-transbronchial needle aspiration specimen preparation in a single institution experience

“…The diagnostic yield of slide cytology and core-tissue are reported to be greater than 80% also in previous series (4,(6)(7)(8). In our study no significant differences were seen between the diagnostic performances comparing these two techniques.…”

“…Also in the literature the combination of two techniques, both slide cytology and cell-block or core tissue, are reported to increase the diagnostic performance of the same methods alone (4,(6)(7)(8). However, processing the specimen in two different ways at the same time requires more resources and raises the question of which method should be trusted in case of discordant results.…”

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

“…Sanz-Santos et al (2012) reported that cell blocks improved the pathological diagnosis attained with conventional smears. The present study indicates that when cytomorphological studies were used in combination with cell blocks, we were able to provide a diagnosis from lymph node EBUS-TBNA samples with good sensitivity and specificity.…”

Diagnostic yield of transbronchial needle aspiration for lymphoma

“…[22] Histological confirmation and subtyping of lymphoma remains the standard precondition for chemotherapy. TBNA/EBUS-TBNA cell block samples [23] and EBUS transbronchial needle forceps biopsies [24] may overcome these deficiencies. The only study done in the last 10 years evaluating the diagnostic yield of conventional (blind) TBNA in the diagnosis of lymphoma (using cytology and/or histology needles) was by Fernández-Villar et al [25] in 2010, on 15 patients with lymphoma.…”

“…The routine immuno phenotypic panel was: CD 3 , CD 4 , CD 5 , CD 8 , CD 10 , CD 19 , CD 20 , CD 22 , CD 23 , CD 38 , CD 45 , FMC-7, kappa and lambda (CD 45 gating strategy). One sample was insufficient for analysis.…”