Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

Abstract

Rationale: Conventional transbronchial needle aspiration (TBNA) and endobronchial ultrasound (EBUS)-TBNA are widely accepted tools for the diagnosis and staging of lung cancer and the initial procedure of choice for staging. Obtaining adequate specimens is key to provide a specific histologic and molecular diagnosis of lung cancer. Objectives: To develop practice guidelines on the acquisition and preparation of conventional TBNA and EBUS-TBNA specimens for the diagnosis and molecular testing of (suspected) lung cancer. We hope to improve the global unification of procedure standards, maximize the yield and identify areas for research. Methods: Systematic electronic database searches were conducted to identify relevant studies for inclusion in the guideline [PubMed and the Cochrane Library (including the Cochrane Database of Systematic Reviews)]. Main Results: The number of needle aspirations with both conventional TBNA and EBUS-TBNA was found to impact the diagnostic yield, with at least 3 passes needed for optimal performance. Neither needle gauge nor the use of miniforceps, the use of suction or the type of sedation/anesthesia has been found to improve the diagnostic yield for lung cancer. The use of rapid on-site cytology examination does not increase the diagnostic yield. Molecular analysis (i.e. EGFR, KRAS and ALK) can be routinely performed on the majority of cytological samples obtained by EBUS-TBNA and conventional TBNA. There does not appear to be a superior method for specimen preparation (i.e. slide staining, cell blocks or core tissue). It is likely that optimal specimen preparation may vary between institutions depending on the expertise of pathology colleagues.

Multicentric study of endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging in Italy

“…In our pooled series of NSCLC patients undergoing mediastinal staging by EBUS-TBNA, the specimen processing technique and the center were not independent factors influencing diagnostic yield, in agreement with previous reports of EBUS-TBNA performance in heterogeneous populations of neoplastic and non-neoplastic patients (9,10). Needle 21-G independently correlated with the EBUS-TBNA diagnostic yield.…”

“…However, our limited experience with ROSE does not allow firm conclusions about the role of this technique. A recent review indicates that ROSE does not modify EBUS-TBNA diagnostic yield and does not affect the number of needle passes, the duration of the procedure, nor the complication rate (9). Conversely, ROSE reduces the number of additional lymph node samplings, especially when EBUS-TBNA represents the first diagnostic procedure in case of suspect lung cancer (9).…”

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

“…We were also supported in our practice by the long experience of gastrointestinal endoscopy in using this kind of sedation, including our hospital [11], and by the absence in literature of clear evidence demonstrating a superior efficiency of general anesthesia or deep sedation during EBUS-TBNA [13,[15][16][17].…”

Disseminated cryptococcosis presenting as mediastinal and hilar lymphadenopathy in an immunocompetent patient

“…The feasibility and accuracy of molecular methods using EBUS‐TBNA specimens have been well established in thoracic malignancies 5. Molecular analysis has a high diagnostic yield and can distinguish between Cryptococcus and the other yeast‐like fungi 6.…”