Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

Steinfort, Daniel P.; Russell, Prudence A.; Tsui, Alpha; White, G. Zachary; Wright, Gavin; Irving, Louis

doi:10.1183/09031936.00109711

Cited by 34 publications

(24 citation statements)

References 35 publications

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“…Regarding cell-block, our results are not as satisfactory as the >80% diagnostic accuracy reported in the literature (3,7,9,10). This discordance could be due in part to our pathologists' scarce confidence with cell-block technique, as cytology slide and core-tissue are the predominantly used methods in our institution.…”

Section: Discussioncontrasting

confidence: 54%

Comparison of multiple techniques for endobronchial ultrasound-transbronchial needle aspiration specimen preparation in a single institution experience

Rotolo¹,

Cattoni²,

Crosta³

et al. 2017

J. Thorac. Dis.

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Background:The optimal method for specimen preparation of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is still controversial. This study aims to compare several techniques available for EBUS-TBNA specimen acquisition and processing, in order to identify the best performing technique. Methods:We retrospectively reviewed the data of 199 consecutive patients [male, 73%; median age, 64 years (IQR: 52-74 years)] undergoing EBUS-TBNA at our institution from 2012 through 2014 for diagnosis of hilar-mediastinal lymph node enlargement suspect of neoplastic (n=139) or granulomatous (n=60) disease. All procedures were performed by two experienced bronchoscopists, under conscious sedation and local anaesthesia, using 21/22-Gauge (G) needle, without rapid on-site evaluation (ROSE). Five specimenprocessing techniques were used: cytology slides in 42 cases (21%); cell-block in 25 (13%); core-tissue in 60 (30%); combination of cytology slides and core-tissue in 51 (26%); combination of cytology slides and cell-block in 21 (10%). To assess the diagnostic accuracy of each tissue-processing technique we compared the EBUS-TBNA results to those obtained with surgical lymphadenectomy, or 1-year follow-up in non-operated patients.Results: Diagnostic yield, accuracy and area under the curve (AUC) were as follows. Cytology slides: 81%, 80%, 0.90; cell-block: 48%, 33%, 0.67; core-tissue: 87%, 99%, 0.96; cytology slides + core-tissue: 80%, 100%, 1.00; cytology slides + cell-block: 86%, 100%, 1.00. Cytology slides and core-tissue method showed non-significantly different diagnostic yield (P=0.435) and AUC (P=0.152).Conclusions: In our single-institution experience, cytology slides and core-tissue preparations demonstrated high and similar diagnostic performance. Cytology slides combination with core-tissue or cell-block showed the highest performance, however these combination methods were more resourceconsuming.

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Section: Discussioncontrasting

confidence: 54%

Comparison of multiple techniques for endobronchial ultrasound-transbronchial needle aspiration specimen preparation in a single institution experience

Rotolo¹,

Cattoni²,

Crosta³

et al. 2017

J. Thorac. Dis.

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“…In our institute a study was carried out to identify the best performing technique among those currently available for EBUS-TBNA specimen acquisition and processing; we found that the diagnostic yield with cytology smear and with core-tissue were high and similar (81% vs. 87%; P=0.44) (22). In the literature, like in our study, the comparison of cytology smear, coretissue and cell-block methods showed that no single method is superior to the others (23,24). Notably, we attained the highest diagnostic yield (100%) by combining two methods (cytology slides and core-tissue, or cytology slides and cellblock); however the use of two methods in combination is expensive and time-consuming (22).…”

Section: Sample Acquisition and Preparation Techniquesmentioning

confidence: 90%

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

2017

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The remarkable value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging of non-small cell lung cancer (NSCLC) is recognized worldwide.Reports from different centers however show considerable variation of EBUS-TBNA performance in terms of diagnostic yield, sensitivity and negative predictive value (NPV). Interpretation of EBUS-TBNA diagnostic efficacy requires clarifying whether the technique is used for purely diagnostic purpose or mediastinal staging, recognizing that different study groups may be inherently heterogeneous and that numerous factors may impact on the procedure outcomes. Review of these factors indicates that the prevalence of N2/N3 disease, the thoroughness of mediastinal sampling and >3 needle passes per target lymph node (LN) [in the absence of rapid on-site evaluation (ROSE)] influence the procedure outcomes, while many details in the sample preparation technique are unlikely to impact on the results and should be left to the proceduralists' preference. Generalized use of a standardized database for prospective collection of relevant EBUS-TBNA data would allow reporting institutional results by subgroups of N2/N3 disease prevalence and thoroughness of staging, and would help establishing quality standards for the procedure.

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“…Thus, the presence of p63 or the absence of TTF-1 is not sufficient to determine histology. The use of IHC improves the classification of NSCLC subtypes [Steinfort et al 2012].…”

Section: Introductionmentioning

confidence: 99%

Novel agents in development for advanced non-small cell lung cancer

Stinchcombe

2014

Ther Adv Med Oncol

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Abstract:The identification of EGFR mutations and ALK rearrangements in nonsmall cell lung cancer (NSCLC) has led to the rapid development of targeted therapies and significant changes in the treatment paradigm. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and crizotinib are now standard therapies for patients with the appropriate molecular alteration. Current investigations are determining the mechanisms of resistance to targeted therapies and developing novel agents to combat resistance. For patients with KRAS mutant NSCLC, a phase III trial of the MEK inhibitor, selumetinib, has been initiated. For patients without a defined mutation or a mutation without a known targeted therapy, immunotherapy, ganetespib, nintedanib and MET inhibitors in combination with EGFR TKIs are in development. Preliminary results of phase III trials raise doubts about the future development of dacomitinib as a second-line agent.

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Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

Cited by 34 publications

References 35 publications

Comparison of multiple techniques for endobronchial ultrasound-transbronchial needle aspiration specimen preparation in a single institution experience

Comparison of multiple techniques for endobronchial ultrasound-transbronchial needle aspiration specimen preparation in a single institution experience

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

Novel agents in development for advanced non-small cell lung cancer

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