Utility of endobronchial ultrasound-guided-fine-needle aspiration and additional value of cell block in the diagnosis of mediastinal granulomatous lymphadenopathy

Abstract

Background:Endobronchial ultrasound-guided transbronchial fine-needle aspiration is a minimally invasive technique for diagnosis of mediastinal lesions. Although most studies have reported the utility of EBUS-FNA in malignancy, its use has been extended to the benign conditions as well.Objective:To evaluate the diagnostic yield and cytologic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-FNA) in cases of clinically and radiologically suspected granulomatous diseases.Patients and Method:From May 2010 to April 2015, 43 of 115 patients who underwent EBUS-FNA at one center for radiologically and clinically suspicious granulomatous lesions, and with no definite histological diagnosis, were included in this retrospective study.Results:When the histological diagnosis was taken as the gold standard, the sensitivity of EBUS-FNA was 85% and specificity was 100% with the positive predictive value of 100. The combined diagnostic sensitivity of EBUS-FNA and transbronchial lung biopsy was 100%. In 4 cases, cell block provided an exclusive morphological diagnosis of sarcoidosis which was noncontributory by EBUS-FNA.Conclusion:Our study supports the use of EBUS-FNA, by virtue of being a safe, minimally invasive, and an outpatient procedure, in the diagnosis of granulomatous mediastinal lymphadenopathy, thereby obviating more invasive testing in a significant number of patients. Also, cell block provides additional data in the diagnosis in these benign mediastinal diseases.

Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology

“…Cytology laboratories use a wide variety of collection media, fixatives, and stains for specimen preparation. A wide range of cytology specimen processing techniques were identified in the systematic review, including CytoLyt (Hologic Inc, Marlborough, Massachusetts), [141][142][143] Hanks, 44 RPMI, 144 saline, 111,132,[145][146][147][148][149][150][151][152][153][154][155] and CytoRich (Becton, Dickinson and Company, Franklin Lakes, New Jersey) 43 as collection media; alcohol, 6,46,115,156 formaldehyde, 112 Mount-Quick, 119 and formalin || as fixatives; and Diff-Quik, 6,44,46,166 Giemsa, 43 and Papanicolaou for staining. 46,167 However, none of the listed studies performed direct comparisons between the different processing techniques that enable making a specific recommendation for the use of one method over another.…”

Bronchoscopic Decompression of Mediastinal Lymph Node Abscess Using Endobronchial Ultrasound

“…It can give access to the mediastinal and hilar lymph node locations commonly involved in TML and also allow bronchial washings to be performed at the same sitting. Studies support that the use of EBUS-TBNA as a minimally invasive technique that can be done even on an outpatient basis and is useful in the diagnosis of granulomatous mediastinal lymphadenopathy obviating the need of invasive procedures in the evaluation of mediastinal lesions [8].…”

Management of cytologic material, preanalytic procedures and biobanking in lymph node cytopathology

“…In the case of specific lymphadenopathies, the examination of CB sections prepared from tissue fragments present in the aspirated material allows observation of the whole morphology of the lesion because the architectural relationship of the different cell types is preserved. This is the case with Kikuchi's disease, Castleman's disease and lymphadenopathies with a granulomatous pattern . CB has been successfully used in LN‐FNC of sarcoidosis and other granulomatous processes on superficial or deeply located LNs (mainly mediastinal) by OUS‐EBUS .…”

“…This is the case with Kikuchi's disease, Castleman's disease and lymphadenopathies with a granulomatous pattern . CB has been successfully used in LN‐FNC of sarcoidosis and other granulomatous processes on superficial or deeply located LNs (mainly mediastinal) by OUS‐EBUS . The main weaknesses of CBs are the scanty cellularity and the occasional absence of tissue fragments …”