Learning Curve of Conventional Transbronchial Needle Aspiration in Pulmonologists Experienced in Bronchoscopy

Hermens, Frank H. W.; Limonard, Gijs; Termeer, René; Berg, Willem van den; Visser, F.J.; Hol, Bernard; Janssen, J.

doi:10.1159/000112793

Cited by 28 publications

(24 citation statements)

References 31 publications

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“…Therefore, current guidelines describe that NSCLC patients with suspected LN involvement should undergo tissue sampling for pathological confirmation before surgical interventions [1,2,3]. For this aim, transbronchial needle aspiration (TBNA) has been sometimes attempted, but the procedure is not easy and the diagnostic yield is not sufficient [28,29]. Recent surgical and mediastinoscopic techniques for N-staging, such as transcervical extended mediastinal lymphadenectomy (TEMLA) and video-assisted mediastinoscopic lymphadenectomy (VAMLA), have become more accurate [30,31], but these procedures are still invasive, costly and require general anesthesia, as well as a long time and substantial manpower.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

et al. 2009

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Background: Mediastinal lymph node staging (N-staging) is essential to optimize the treatment in non-small cell lung cancer (NSCLC). Transesophageal endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has recently been introduced as a complementary method. However, in most reports, EUS-FNA has been performed in patients who have demonstrated enlarged lymph nodes (LNs) on CT findings. The yield of EUS/EUS-FNA in patients without enlarged mediastinal LNs by CT has so far only been evaluated in a few reports. Aims: Our aim was to compare the diagnostic accuracy of CT and EUS with or without EUS-FNA (EUS/EUS-FNA) prospectively, for N-stage in all patients with potentially resectable NSCLC, including patients with and without mediastinal LN enlargement based on CT findings. Methods: Eighty consecutive patients with potentially resectable NSCLC based on CT findings were enrolled in this prospective comparative study, and underwent EUS/EUS-FNA. Results: Pathological N-stage was established in 78 patients, while in another 2 cases, malignant pleural effusion was proven by EUS-FNA, and we avoided further N-staging. In the 78 patients, the prevalence of malignant mediastinal LNs was 21%. The accuracy of EUS/EUS-FNA (91%) was significantly higher than that of CT (71%). The negative predictive value of EUS/EUS-FNA was 90%. In addition, EUS-FNA identified 2 patients as N3 disease in 56 patients without mediastinal LN involvement on CT. Conclusions: EUS/EUS-FNA gave more accurate N-staging in patients with possibly resectable NSCLC than CT, and is thus considered to be useful to determine the optimal treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

et al. 2009

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“…However, TBNA of a mediastinal lymph node can be successfully performed by every bronchoscopist. Hermens et al [27] showed in a small group of pulmonologists already experienced in bronchoscopy that the diagnostic yield of TBNA in mediastinal lymph nodes was related to lymph node size, but not to lymph node location and bronchoscopist experience with TBNA. In our study, TBNA was the most frequently performed diagnostic procedure in 59% of patients without any associated complications.…”

Section: Discussionmentioning

confidence: 99%

Patients’ Satisfaction with Flexible Bronchoscopy in a Hospital-Based Community Practice

Bernasconi

Chhajed²,

Müller³

et al. 2009

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Background: There are no data about patients’ satisfaction with a first bronchoscopy in community practice. Objectives: The aim of this study was to assess the satisfaction with flexible bronchoscopy and the willingness to return for the procedure if needed in hospital-based community practice. Methods: Prospective administration of a questionnaire before and after flexible bronchoscopy with inclusion of 126 patients in the analysis. Results: The reliability analysis demonstrated a good internal consistency of the questionnaire with a mean Cronbach α of 0.7 (range 0.63–0.76). Health status and overall satisfaction with bronchoscopy were reported as poor by 31 (25%) and 0 (0%) patients, fair by 34 (27%) and 3 (2%) patients, good by 47 (37%) and 51 (40%) patients and very good by 9 (7%) and 70 (56%) patients, respectively. Overall willingness to return for a flexible bronchoscopy if necessary was 98% (123/126). Transbronchial needle aspiration (TBNA) was the most often performed diagnostic procedure (74/126, 59%). Mean duration of the bronchoscopy in patients with and without TBNA was 30 and 19 min, respectively (p < 0.001). However, TBNA did not influence patient’s satisfaction. Preprocedure anxiety was reported by 26 of 51 patients (51%) and 24 of these patients (92%) rated their anxiety as unjustified after the procedure. Conclusions: Overall satisfaction and willingness to return for a flexible bronchoscopy in community practice are extremely high and these are independent of whether TBNA is undertaken or not.

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“…The presence of on-site evaluation is advocated for the determination of material adequacy, reduction of nondiagnostic rate, and preliminary diagnoses. [20][21][22][23][24][25] Some authors have also reported that appropriate training can dramatically increase the performance of onsite evaluation. 26 In addition, on-site evaluation allows for proper triaging of specimens, requesting further sampling when additional specimen is needed for ancillary studies, such as cell block, flow cytometry, and microbiology culture.…”

Section: Adenocarcinoma (Nos¼1) Suspicious For Bac (N¼1)mentioning

confidence: 99%

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

Feller‐Kopman

Yung

Burroughs

et al. 2009

Cancer Cytopathology

103

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BACKGROUND:Endobronchial ultrasound (EBUS) is a relatively new modality that can be used to guide transbronchial needle aspiration (TBNA) of mediastinal and hilar lymph nodes and peripheral lung lesions. Few studies have investigated the cytological profile of EBUS‐TBNA specimens. In this study, we have reviewed the cytological profile of 135 consecutive cases, including 71 lymph node cases, 4 lung cases, and 60 cases of both lymph node and lung sampling. Our study contains the largest number of cases in the evaluation of cytomorphology.METHODS:The cytological specimens were collected using an ultrasound bronchofibervideoscope with a 22‐gauge needle and core biopsies were obtained with a 19‐gauge needle. An experienced cytotechnologist performed an immediate on‐site evaluation of adequacy. An immediate assessment was given to the clinician after each pass. In many patients, multiple sites were sampled. The average slides of each case were 9.9 (median of 12), with a range from 2 to 24.RESULTS:Of 131 cases of lymph node sampling, 45 cases (34.6%) were diagnosed as malignant, 73 cases (55.7%) as benign process, 5 cases (3.8%) as suspicious for malignancy, and 1 case (0.8%) as atypical cells. Of the 64 cases of lung lesion sampling, 21 cases (32.8%) were diagnosed as malignant, 35 cases (54.7%) as benign process, 1 case (1.5%) as suspicious for malignancy, and 4 cases (6.3%) as atypical cells. The lymph node nondiagnostic rate was 5.3%, whereas the nondiagnostic rate for lung lesions was 4.7%. Eighty‐eight cases (65.2%, 88/135) had corresponding core biopsies (with a 19‐gauge needle) or follow‐up surgery. When histology was taken as the gold standard, the sensitivity, specificity, and positive and negative predictive values for EBUS‐TBNA were 85.0%, 100%, and 100% and 89.7%, respectively. However, when both histology and clinical follow‐up were considered together, the overall sensitivity and negative predictive values were increased to 94.7% (P < .05) and 96.6% (P < .05), respectively.CONCLUSIONS:This study shows that EBUS‐TBNA is an accurate and sensitive method for diagnosing and staging lung cancer. The constant challenge that we as cytopathologists are now facing is how to improve our diagnostic ability and accuracy for lung cancer. We believe that this optimal goal can be achieved with the effective use of EBUS‐TBNA sampling and collaboration with our clinical colleagues. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

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Learning Curve of Conventional Transbronchial Needle Aspiration in Pulmonologists Experienced in Bronchoscopy

Cited by 28 publications

References 31 publications

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

Patients’ Satisfaction with Flexible Bronchoscopy in a Hospital-Based Community Practice

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

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