Role of Endobronchial ultrasound guided transbronchial needle aspiration with cellblocks in diagnosis and subtyping of intrathoracic lesions: Two year experience from a tertiary care center

Verma, Vikrant; Khan, Ajmal; Rao, Ram Nawal; Nath, Alok; Hashim, Zia

doi:10.4103/joc.joc_55_21

Cited by 2 publications

(2 citation statements)

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“…The frequency of malignant EBUS-TBNA samples was 18.4-33.9% in the total population (ages 27-91 years old with a mean age of 61 years; ages 17-94 years old with a median age of 65.5 years) [1,11]. It was reported that 27.8-64.4% of patients had neoplastic diagnosis in patients who underwent EBUS-TBNA for intrathoracic lesions (ages 14-85 years old with a mean age of 48.4 years; ages 11-89 years old with a mean age of 63.5 years) [12,13]. In addition, the frequent disease types were different from those in older adults.…”

Section: Discussionmentioning

confidence: 99%

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Lung and Mediastinal Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Young Adults

Seki

Chute

2022

Acta Cytologica

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used to investigate pulmonary nodules, mediastinal lymphadenopathy, and mediastinal masses in both malignant and nonmalignant etiologies. EBUS-TBNA is most commonly used in the diagnosis and staging of patients with non-small-cell lung cancer in the middle-age and elderly populations. As lung cancer is uncommon in young adults, it is assumed that there are a distinct disease population and clinical background in young adults who undergo EBUS-TBNA. However, this population has not been well investigated. Methods: We identified all EBUS-TBNA cases in young adults (aged 18–39 years) between January 1, 2008, and December 31, 2018, at our institution. Cytology diagnoses were correlated with the concurrent/subsequent histologic diagnosis and clinical decisions. A final patient classification was created based on the worst cytologic or histologic diagnosis (benign, low-grade, or malignant), with the exception of atypical cytology with subsequent long clinical follow-up with no evidence of malignancy, who were considered benign. All discordant cases and positive/suspicious cases with available slides were rereviewed together by the authors to confirm the diagnosis. Results: In total, 257 EBUS-TBNA procedures were performed in 249 young adults (mean age of 31.2 years). The majority of indications were lymphadenopathy and lung nodule/mass. Final cytologic interpretations included 214 (83%) benign, 14 (5%) atypical, 5 (2%) low-grade neoplasm (carcinoid tumor), and 15 (6%) malignant cases. The final patient classification was 213 (86%) benign, 6 (2%) low-grade, and 30 (12%) malignant. Discordant results were found in 24 cases, most frequently due to sampling error (50%). Of 213 benign cases, 58% had granulomatous disease, with sarcoidosis being the most common, followed by histoplasmosis. Of 30 cases with a final malignant classification, metastatic tumor was the most common (n = 12, 4.8%), followed by primary lung tumor (n = 11, 4.4%) and lymphoma (n = 7, 2.8%). There was a variety of malignancies among primary lung cancer, including adenocarcinoma (n = 5), squamous-cell carcinoma (n = 3), inflammatory myofibroblastic tumor (n = 2), and epithelioid hemangioendothelioma (n = 1). Conclusion: In young adults, EBUS-TBNA was most frequently performed to evaluate lymphadenopathy and lung nodules, and granulomatous disease was the most common benign finding. Although rare, primary lung malignancies do occur in young adults along with metastasis from a variety of other sites, with sarcoma being the most common pathology.

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Section: Discussionmentioning

confidence: 99%

“…The most common location was a lymph node (83.3%). The mean number of needle passes from each site was 3.6 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). ROSE was performed in 91.8% of cases (236 cases) and correlated well with the final cytologic interpretation in 97.9%.…”

Section: Cytologic Findingsmentioning

confidence: 99%

Lung and Mediastinal Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Young Adults

Seki

Chute

2022

Acta Cytologica

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Cytokeratin 19 expression in intrathoracic neoplasms: First study utilizing cellblocks, evaluating the role of a rarely used cytokeratin for lung cancers

Verma

Rao

2022

Diagnostic Cytopathology

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Background Cytokeratin 19 (CK19) is low‐molecular weight CK with widespread expression in various malignancies including those of lung, colon, and breast. Occasional studies have also indicated prognostic utility of CK19 in nonsmall cell lung carcinomas, with better prognosis among squamous cell carcinoma cases with strong CK19 immunostaining. The aim of this study was to evaluate the expression and potential roles of CK19 immunostaining in cases of carcinoma lung as well as other metastatic intrathoracic neoplasms. Methods This was a prospective single‐center study of 2 years duration, during which 233 cases of endobronchial ultrasound guided aspiration of the intrathoracic lesions were examined. After excluding the cases without cellblock, with inadequate samples, with benign diagnosis, and excluding the lymphoma cases, finally 31 neoplastic cases were evaluated for expression of cytokeratin 19. Results Diffuse cytoplasmic staining for CK19 was noted in nonsmall cell lung carcinomas (18/19 cases), while the expression in small cell carcinomas was low (2/5 cases). CK19 was also positive in mediastinal lymph node metastasis from a case each of papillary thyroid carcinoma, prostatic adenocarcinoma and infiltrating ductal carcinoma breast (1/2 cases). It showed focal faint staining in a case of mediastinal mesenchymal neoplasm and was negative in both the cases of primitive neuroectodermal tumor. Conclusions CK19 is a highly sensitive but nonspecific marker for nonsmall cell lung cancers. However, owing to diffuse staining pattern in most of these cases, role of its staining intensity as a predictor of prognosis could not be evaluated.

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Role of Endobronchial ultrasound guided transbronchial needle aspiration with cellblocks in diagnosis and subtyping of intrathoracic lesions: Two year experience from a tertiary care center

Cited by 2 publications

References 20 publications

Lung and Mediastinal Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Young Adults

Lung and Mediastinal Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Young Adults

Cytokeratin 19 expression in intrathoracic neoplasms: First study utilizing cellblocks, evaluating the role of a rarely used cytokeratin for lung cancers

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