Diagnostic performance of 19‐gauge endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in suspected lymphoma: A prospective cohort study

Abstract

Introduction Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) represents a minimally invasive approach in the evaluation of mediastinal/hilar lymphadenopathy. Diagnostic performance of EBUS‐TBNA in lymphoma using standard 22‐gauge (22G) needle is limited by sample volumes that are often inadequate for histopathological assessment. Objectives To evaluate the diagnostic utility of 19‐gauge (19G) EBUS‐TBNA needle in the evaluation of suspected lymphoma. Methods We prospectively collected clinical and procedural information for patients undergoing EBUS‐TBNA with 19G needle at Royal Melbourne Hospital for investigation of mediastinal/hilar lymphadenopathy, where lymphoma was considered in the differential diagnosis. All consecutive patients between June 15, 2016 and July 10, 2019 were included. If definitive diagnosis was not achieved on EBUS‐TBNA, final diagnosis was determined through subsequent investigation or a minimum of 6 months radiologic surveillance. Results Thirty‐nine patients underwent EBUS‐TBNA using 19G needle for evaluation of suspected lymphoma. Thirteen patients had a prior diagnosis of lymphoma (33%). Lymphoma was ultimately diagnosed in 23 patients (59%). Of these, 10 had a prior diagnosis of lymphoma (43%). 19G EBUS‐TBNA demonstrated lymphoma in 19 patients, with a sensitivity of 83% (95% CI 66‐93) for detection of lymphoma. Four patients required surgical biopsy to definitively characterise lymphoma subtype. Therefore, sensitivity of 19G EBUS‐TBNA for definitive diagnosis of lymphoma was 65% (95% CI 45‐81). In patients with a prior diagnosis of lymphoma, sensitivity for definitive diagnosis of lymphoma was 80% (95% CI 48‐95). Conclusion Diagnostic performance of 19G EBUS‐TBNA appears similar to standard 22G needle in detection and definitive diagnosis of lymphoma. Further invasive testing remains necessary following non‐diagnostic EBUS‐TBNA procedures.

Lung cancer biopsies: Comparison between simple 22G, 22G upgraded and 21G needle for EBUS-TBNA

“…However, this should be another study evolving other types of cancer such as lymphoma because 19G is mostly used when there is a suspicion of such case [17]. However; we should mention that in the study by Lim CE et al [17] and Elmufdi FS et al [18] when the 22G was compared to 19G needle the results were similar for the diagnosis of lymphoma. Therefore, we should always keep in mind that the EBUS operator must have a pathology department with sufficient experience.…”

“…We can diagnose B-, T-Non-Hodgkin lymphoma and other hematological malignancies from cell blocks (22G needles) [19,27]. In order to diagnose Hodgkin lymphoma we need larger tissue samples with specific architecture, which is not possible with smaller samples such as 22G and 21G [17]. However, in several cases this is not possible even with 19G needles.…”

The milky way

“…Overall, surgical biopsy, which allows complete morphological, cytogenetic, immunophenotypical and molecular analysis, is recommended by current guidelines [11]. Indeed, our patient underwent mediastinoscopy without complications, although this procedure has a higher mortality than EBUS-TBNA (0.2% vs 0.01%) and is particularly complicated in patients who have previously treated with mediastinal radiotherapy [9].…”

“…Nonetheless, the samples obtained are generally small and the fibrotic process that often occurs in lymphomas may decrease the diagnostic sensitivity, particularly in the nodular sclerosing variant of Hodgkin lymphoma, which is characterized by its hypocellularity. It has been argued that the use of a bigger needle (22 vs 19 G) might increase diagnostic accuracy [9]. The limited data available confirm the low diagnostic yield of this procedure, although with an overall specificity approaching 100% [10].…”

Lymphadenopathy and Granulomas: Benignancy of Malignancy and Differential Diagnosis with Endobronchial Ultrasound-Transbronchial Needle Biopsy 19G Needle Fine-Needle Aspiration Biopsy

“…Blood tests should be performed simultaneously when investigating collagen disease. The issue of the EBUS sample has nowadays been resolved with the use of larger needles like the 19G needle [ 16 ]. This means the sample size is larger and cell blocks have enough tissue sample to diagnose lymphoma, sarcoidosis and other types of cancer (metastatic) [ 16 ].…”