Diagnostic yield of EBUS-TBNA for lymphoma and review of the literature

Abstract

Aim:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which enables cytological examination of mediastinal lymph node (LN) aspiration samples, is a safe and minimally invasive method for diagnosis and staging of lung cancer and diagnosis of diseases affecting mediastinal LNs. In this study, we investigated the yield of EBUS-TBNA for diagnosis of lymphoma and reviewed the literature since the British Thoracic Society (BTS) guidelines were published.Materials and Methods:We retrospectively evaluated our database for patients who underwent EBUS between March 2011 and December 2014. One hundred eighty-nine patients with isolated mediastinal lymphadenopathy were included in the study. Patients with other causes of lymphadenopathy, such as lung cancer or extrathoracic malignancy, and those with pulmonary lesions accompanying mediastinal lymphadenopathy were excluded from the study. Patients with final diagnosed lymphoma were included in the study on the basis of a history of lymphoma or newly evaluated mediastinal lymphadenopathy. The sensitivity and negative predictive value (NPV) of EBUS-TBNA were calculated.Results:There were 13 patients with the final diagnosis of lymphoma. Eleven of them were new diagnoses and 2 patients were known chronic lymphocytic leukemia (CLL), and underwent EBUS-TBNA for determination of recurrence. Twelve EBUS-TBNA procedures were performed for suspected new cases. Three (25%) were diagnostic, 2 (16.7%) were suspicious for lymphoma and underwent further interventions for definite diagnosis, and 7 (58.3%) were false negative. All 3 patients diagnosed with EBUS-TBNA were non-Hodgkin lymphoma (NHL). None of the Hodgkin lymphoma (HL) cases could be diagnosed with EBUS-TBNA. The overall diagnostic sensitivity and NPV of EBUS-TBNA in detecting lymphoma was 65% and 96.1%, respectively. For the newly diagnosed lymphoma cases, EBUS-TBNA had a sensitivity of 61.1%.Conclusion:In conclusion, we believe that since the publication of the BTS guidelines, the value of EBUS-TBNA in the diagnosis of lymphoma still remains controversial. EBUS-TBNA can be the first diagnostic modality in diagnosis of recurrent lymphomas. However, for suspected new cases, especially for HL, the diagnostic yield of EBUS-TBNA is low and negative results do not exclude lymphoma. Further interventions such as mediastinoscopy should be performed for high-suspicion patients.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Technical Updates and Pathological Yield

“…In one of the largest studies, which included 75 patients with a final diagnosis of lymphoma, EBUS-TBNA was able to establish a diagnosis in 84% of the patients and was able to subtype lymphoma in 67% of de novo cases and in 81% of the relapsed cases [ 60 ]. The lowest yield was in patients with Hodgkin’s lymphoma compared with non-Hodgkin’s lymphoma [ 60 ], and in newly diagnosed compared with recurrent lymphoma [ 60 , 61 ]. Moonim et al prospectively reviewed 100 cases of suspected lymphoma sampled by EBUS-TBNA.…”

Deep learning with convex probe endobronchial ultrasound multimodal imaging: A validated tool for automated intrathoracic lymph nodes diagnosis

“…U-Net[ 1 ] is widely used in medical image segmentation and achieves excellent performance in a variety of segmentation tasks, and much effort[ 2 3 4 ] has been made for further improvement. We evaluate the segmentation performance by various U-Net based methods on our dataset to determine the proper architecture for EBUS images.…”

“…Convex probe endobronchial ultrasound-guided transbronchial needle aspiration (CP-EBUS-TBNA) is a minimally invasive diagnostic tool for intrathoracic lymph nodes (LNs). [ 1 2 ] However, the samples obtained by puncture needles cannot reflect the entire LN, especially for the diagnosis of various benign diseases and LNs with tumor micrometastasis. Although a 90% average diagnosis rate for lung cancer can be reached, a 20% false negative is still possible.…”

Utility and Safety of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Isolated Mediastinal Masses

“…30 The poor accuracy of EBUS-TBNA in the diagnosis of lymphoma has been previously reported. 31,32 In the case of seminoma, only crushed small round cells are found in the background of blood clots in the EBUS-TBNA specimen. This is consistent with the pathologic features of seminoma, which always include necrosis.…”