Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA): An overview and update for the cytopathologist

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive technique for evaluating the mediastinum and staging patients with lung cancer. In the hands of an experienced operator, the procedure is safe and provides excellent sensitivity, specificity, and predictive diagnostic values. In conjunction with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), a nearly complete mediastinal evaluation can be performed in a minimally invasive fashion. This strategy results in improved lymph node staging, markedly reduced need for mediastinoscopy, and fewer futile thoracotomies compared with a traditional surgical staging procedure. The procedure is cost effective and provides excellent cytologic specimens that have proven well suited for ancillary testing, such as immunohistochemistry and tumor genotyping. EBUS-TBNA, initially used as a tool to sample the lymph nodes adjacent to the airway walls, has now become instrumental in sampling lesions in the mediastinum, hilum, and lung parenchyma, where previously more than 1 procedure would have been necessary. Looking forward, expanded use of this procedure is likely to revolutionize the access to cytology-proven staging and restaging of lung cancer and other thoracic malignancies in a

Endobronchial ultrasound-transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: variability of results and perspectives

“…The success in performing molecular tests on TBNA samples depends on the absolute number and percentage of malignant cells present in the sampled material, on quality of cell preservation and on type and sensitivity of the test itself (17,39). Recent reports from high-volume centers indicate that 72-97% of EBUS-TBNA samples are appropriate for testing the most frequently used prognostic markers of lung cancer, namely EGFR, ALK and KRAS (17,25,39,40).…”

“…The success in performing molecular tests on TBNA samples depends on the absolute number and percentage of malignant cells present in the sampled material, on quality of cell preservation and on type and sensitivity of the test itself (17,39). Recent reports from high-volume centers indicate that 72-97% of EBUS-TBNA samples are appropriate for testing the most frequently used prognostic markers of lung cancer, namely EGFR, ALK and KRAS (17,25,39,40). Both smear and cell block preparation, or core tissue, can be utilized for molecular testing (17,23); however, while EGFR and KRAS status can be determined using all three specimen preparation techniques, the ALK translocation is best assessed using cell block and core tissue (17).…”

Antiplatelet Exposure and Bleeding Events in Patients Undergoing EBUS-TBNA

“…The exposed cohort was more likely to be older and have higher rates of COPD, CAD/MI, CVA/TIA, and HTN than were patients in the experienced operators, EBUS with TBNA has improved the overall safety, sensitivity, and specificity of obtaining tissue from the mediastinum [6][7][8][9]. In a large cohort of more than seven thousand patients undergoing EBUS-TBNA, adverse events occurred in 1.23% of patients, with the most common issue being bleeding (0.68%); however, antiplatelet use was not thoroughly documented in this population [10].…”

‘Six Memos' for Lymph Node Fine-Needle Cytology and Flow Cytometry

“…An FNC-FC diagnosis of benign and malignant lymphoproliferative processes is very helpful, and greater advantages may be obtained in the case of deeply located LNs. Transesophageal endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS) have gained a central role in the diagnosis of deeply located LNs [11,12,13]. Their application is focused on the staging of tumors from lung and other organs but, dealing with LNs, EUS/EBUS also explore lymphoproliferative processes.…”