Transbronchial needle aspiration under direct endobronchial ultrasound guidance of PET-positive isolated mediastinal adenopathy in patients with previous malignancy

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently developed, accurate, safe and cost-effective technique that allows sampling of mediastinal lymph nodes and peribronchial lesions including pulmonary and mediastinal lesions. Its major indications are the nodal staging of non-small cell carcinomas of the lung, their restaging after chemotherapy and/or radiation, the diagnosis of sarcoidosis and of metastases from extrathoracic malignancies, and the diagnosis of mediastinal lymphadenopathy and masses of unknown aetiology. From our experience at the University of Minnesota and a comprehensive review of the literature, we discuss technical aspects of the procedure, its advantages and limitations in comparison with other methods of sampling mediastinal lymph nodes, focusing on the role of the cytopathologist in ensuring the effectiveness of the procedure. An algorithmic approach to the cytological diagnosis, starting with the determination of the adequacy of the sample, is also presented.

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“…43 However, abundant material can be obtained, and cell blocks prepared from such samples may allow the evaluation of histological detail.…”

Section: Size Of Needlementioning

confidence: 99%

“…It is expected that core needles that allow histological sampling will soon also become commercially available for EBUS-TBNA. 43…”

Section: Size Of Needlementioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology: a state of the art review

2010

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“…In addition to an important role in establishing staging information, CP EBUS-TBNA application to evaluate recurrent lymphadenopathy in the setting of prior malignancy was extremely effective in confirming malignant recurrence (97.4% sensitivity) (46). Moreover, in a patient population with extrapulmonary malignancies and possible pulmonary metastases being considered for metastasectomy, CP EBUS-TBNA demonstrated mediastinal and/or hilar lymph node metastases in 56% of patients, thereby guiding the decision regarding metastasectomy (47).…”

Section: Lung Cancer Stagingmentioning

confidence: 99%

Advances in Diagnostic Bronchoscopy

Haas

Vachani

Sterman

2010

Am J Respir Crit Care Med

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Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.

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“…5,6 Several studies have demonstrated the effectiveness of EBUS-TBNA for invasive nodal staging of lung cancer, for tissue sampling for mediastinal and lung tumors, and for the diagnosis of lymphoproliferative disorders. 2,[7][8][9][10] However, studies correlating EBUS-TBNA cytology with PET-CT findings are limited and are often small collections of cases. In this study, we compared the cytologic and clinical findings of PET-CTpositive/cytologically malignant (PET-CTþ/Cytoþ) versus PET-CT-positive/cytologically benign (PET-CTþ/CytoÀ) lymph nodes sampled by EBUS-TBNA in a large series of patients at a cancer center.…”

mentioning

confidence: 99%

Cytologic Evaluation of Positron Emission Tomography-Computed Tomography–Positive Lymph Nodes Sampled by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Experience at a Large Cancer Center

Gan

Stewart

Valik

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is routinely used to evaluate mediastinal lymph nodes (LNs), especially for cancer staging. There are limited large studies evaluating the cytologic, radiologic, and clinical features of 18F-fluorodeoxy glucose positron emission tomography-computed tomography–positive (PET-CT+) LNs. Objective.— To compare cytologic, radiologic, and clinical features of PET-CT+, cytology-malignant (PET-CT+/Cyto+) and PET-CT+, cytology-benign (PET-CT+/Cyto−) LNs. Design.— The pathology database was searched for cases of mediastinal LNs obtained by EBUS-TBNA from January 1, 2015 to December 31, 2015. The cytologic, radiologic, and clinical features were collected for all PET-CT+ LNs. Results.— Of 2267 mediastinal LNs obtained by EBUS-TBNA during this period, 577 LNs met the criteria. Of the latter, 263 (46%) were PET-CT+/Cyto+ and 314 (54%) were PET-CT+/Cyto−. All of the patients with PET-CT+/Cyto+ results had a prior or concurrent diagnosis of malignancy as compared to 89% of patients with PET-CT+/Cyto− results. Of the 224 patients with PET-CT+/Cyto+ LNs, 177 (79%) had metastases from lung primary, 43 (19%) had metastases from nonlung primaries, and 7 (3%) had lymphoma. Average LN size was larger in the PET-CT+/Cyto+ group than in the PET-CT+/Cyto− group (14.6 mm versus 9.58 mm), and mean standardized uptake value in PET-CT+/Cyto+ LNs was higher than that of PET-CT+/Cyto− LNs (10.05 versus 5.99). Significant cytologic findings in PET-CT+/Cyto− cases were necrosis and granulomatous inflammation, including 3 cases with fungal organisms. Conclusions.— PET-CT positivity alone was nonspecific for malignancy and insufficient to guide management of patients with mediastinal adenopathy, but specificity could be improved when combined with LN size and standardized uptake value.

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Transbronchial needle aspiration under direct endobronchial ultrasound guidance of PET-positive isolated mediastinal adenopathy in patients with previous malignancy

Cited by 15 publications

References 12 publications

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology: a state of the art review

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology: a state of the art review

Advances in Diagnostic Bronchoscopy

Cytologic Evaluation of Positron Emission Tomography-Computed Tomography–Positive Lymph Nodes Sampled by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Experience at a Large Cancer Center

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