Easily detectable cytomorphological features to evaluate during ROSE for rapid lung cancer diagnosis: from cytology to histology

Abstract

In lung cancer patients, the only available diagnostic material often comes from biopsy or from cytological samples obtained by fine needle aspiration (FNA). There is a lack of easily detectable cytomorphological features for rapid on-site evaluation (ROSE) to orient lung cancer diagnosis towards a specific tumor histotype. We studied the cytological features evaluated on site to define tumor histotype and to establish the number of specimens to be taken. Cytological specimens from 273 consecutive patients were analyzed with ROSE: bronchoscopy with transbronchial needle aspiration (TBNA) had been performed in 72 patients and with endobronchial ultrasound (EBUS)-TBNA in 201. Cytomorphological features were correlated with the final diagnosis and diagnostic accuracy was measured. Analysis of the different cytomorphological parameters showed that the best sensitivity and specificity were obtained for adenocarcinoma by combining the presence of nucleoli and small/medium cell clusters, and for squamous cell carcinoma by considering the presence of necrosis ≥50% and large cell clusters. For small cell carcinoma, the best diagnostic accuracy was obtained by combining moderate necrosis (<50%) and the presence of single cells. Overall accuracy ranged from 90% to 97%. We showed that it was possible to establish the histotype of the most frequent lung cancers during ROSE using only a few easily identifiable cytomorphological parameters. An accurate diagnosis during ROSE could help endoscopists to decide how many tumor samples must be taken, e.g.a higher number of samples is needed for the biomolecular characterization of adenocarcinoma, whereas one sample may be sufficient for squamous cell carcinoma.

The Morphological Analysis of Cells in the Bronchoscopic Brushing and TBNA of Patients with Lung Adenocarcinoma

“…However, accurate interpretation of the morphological characteristics and arrangements of lung adenocarcinoma cytology has not been reported. Ravaioli et al believed that the best way to interpret lung adenocarcinoma cells was to combine nucleolus with medium/small cell mass 11 , and it was also reported that accurate cell typing of nonsmall cell lung cancer (NSCLC) could be achieved by TBNA, but the specific morphological characteristics of NSCLC were not discussed in detail 12 – 14 . In this study, we found that the premise of accurate interpretation of lung adenocarcinoma cytology is to first understand the morphological characteristics of normal bronchial epithelial cells.…”

The role of endobronchial ultrasound elastography in the diagnosis of mediastinal and hilar lymph nodes

“…It is noteworthy that precise molecular testing for genetic alterations needs adequate specimens. For these inoperable patients, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been demonstrated to be a minimally invasive technique for mediastinal node sampling and EBUS-TBNA specimens show high clinical utility for molecular testing, including EGFR mutations, KRAS mutations and ALK rearrangements [ 5 - 12 ].…”

Are fine‐needle aspiration biopsy‐derived cell blocks a useful surrogate for tissue samples in breast cancer?

“…Notwithstanding the small number of cases analysed, our findings confirm that FNAB‐derived cell blocks are useful for assessing prognosis and guiding therapeutic strategies. Cytological samples, in particular cell blocks, are often used for diagnosis, subtype classification and biomarker assessment in advanced non‐small‐cell lung cancer . However, the role of FNAB‐derived cell blocks for biomarker detection in BC has yet to be clarified.…”

“…Cytological samples, in particular cell blocks, are often used for diagnosis, subtype classification and biomarker assessment in advanced non-small-cell lung cancer. [19][20][21] However, the role of FNAB-derived cell blocks for biomarker detection in BC has yet to be clarified.…”