P1-177: The cytopathologic diagnoses of fine needle aspirations from endoscopic ultrasound of the mediastinum:Reproducibility of the diagnoses and representativeness of aspirates from lymph nodes.

Abstract

Background: The expression of vascular endothelial growth factors (VEGFs) in tumors including lung cancer is considered to be associated with tumor development via angiogenesis and lymphangiogenesis. Pleural dissemination and lymph node metastasis of lung cancer are major poor prognostic factors. We investigate how VEGF-A, VEGF-C, and VEGF-D expressed in the intrathoracic infiltrating lung cancer cells are involved in dissemination and metastasis. Methods: We established large cell lung cancer cell lines in which stably VEGF-A-, VEGF-C-, VEGF-D-, or VEGF-C and VEGF-D were stably expressed (TKB5/VEGF-A, TKB5/VEGF-C, TKB5/VEGF-D, TKB5/VEGF-C/D, respectively). These transfectants were orthotopically inoculated into the right thoracic cavity (i.t.) of nude mice, and then we evaluated subsequent development of pleural effusion, pleural dissemination, and lymph node metastasis. Results: There were no significant differences in cell growth rate among the control lines (empty vector-transfected TKB5) and VEGFtransfectants in vitro. However, each i.t. model demonstrated significantly different biological properties. TKB5/empty showed no apparent pleural effusion, dissemination, or lymph node metastasis. In contrast, TKB5/VEGF-A, TKB5/VEGF-C, TKB5/VEGF-D, and TKB5/VEGF-C/D promoted bloody pleural effusion and dissemination (4/4, 4/7, 4/4, and 5/10, respectively). TKB5/VEGF-D and TKB5/VEGF-C/D showed aggressive mediastinal invasion around the thoracic aorta and thoracic duct. Furthermore, TKB5/VEGF-C/D generated mediastinal lymph node metastasis (2/10). These findings suggested that VEGF-D could facilitate mediastinal spread of lung cancer cells. Immunohistochemical study revealed that the expression of both VEGF-A and VEGF-D in the disseminated tumor promoted intense blood vessel formation rather than lymph vessel formation. In contrast, TKB5/VEGF-C showed mild increase of lymph vessel density and significantly low blood vessel density in the disseminated tumor. Conclusions:The biological behavior of lung cancer cells within the thoracic cavity appears to be regulated by expression patterns of VEGFs. The regulation of the expression of VEGFs in intrathoracic lung cancer cells might be a useful therapeutic approach to inhibit tumor development and improve patient prognosis.

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

“…Considering that the samples collected at each biopsy/puncture should be distributed on four or more slides, which should be rapidly placed in 70% alcohol to avoid artifacts, it is clear that there is need for trained and qualified in-room personnel to perform the procedures. (10) Inappropriate slide preparation, which certainly occurred at the beginning of our experience, probably contributed to the large number of tests whose results were classified as "inappropriate sample" or inconclusive.…”

Cytology of endobronchial ultrasound‐guided transbronchial needle aspiration

“…[16][17][18] Studies have also shown that EBUS-TBNA has a higher sensitivity and specificity than mediastinoscopy, EUS, and conventional TBNA in staging and diagnosing lung lesions. 3,4,5,13,14,16,17 Several types of specimens can be obtained with EBUS guidance, including needle aspiration, brushing, washing, lavage, and core needle biopsy. 4,6,7,19 Direct smears can be made from needle aspiration and brushing specimens to allow on-site evaluation.…”

“…3,4,5,13,14,16,17 Several types of specimens can be obtained with EBUS guidance, including needle aspiration, brushing, washing, lavage, and core needle biopsy. 4,6,7,19 Direct smears can be made from needle aspiration and brushing specimens to allow on-site evaluation. The other materials are usually processed in the cytology laboratory and, subsequently, evaluated by cytology personnel.…”

“…More recently, however, a bronchoscope equipped with a convex ultrasound probe has been developed to target and guide a dedicated aspiration needle to obtain the specimen with real-time visualization. [1][2][3] The technique has been widely used in Japan and Europe because it offers an opportunity for prompt and accurate diagnosis, [1][2][3][4] and its use is also increasing in the United States.…”

“…We believe that this optimal goal can be achieved with the effective use of EBUS- Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively new and minimally invasive procedure for sampling mediastinal and hilar lymph nodes. [1][2][3][4][5][6][7][8][9][10] In the mid 1990s, EBUS-TBNA described the use of a 20 MHz radial ultrasound probe to identify lymph nodes and guide sampling of peripheral lung lesions. The ultrasound probe was then removed, and the lymph node punctured in the standard manner.…”