Yield of EBUS-TBNA for the diagnosis of sarcoidosis: impact of operator and cytopathologist experience

Navasakulpong, Asma; Auger, Manon; Gonzalez, Anne V.

doi:10.1136/bmjresp-2016-000144

Cited by 56 publications

(27 citation statements)

References 22 publications

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“…Another point to consider is the experience of the bedside cytopathologist. It has been previously reported by Navasakulpong et al that the experience of the cytopathologist can influence the results of EBUS‐TBNA, which is also applicable to the results of ROSE . In our study, ROSE was reported as non‐diagnostic initially in 12/30 patients by the bedside pathologist, which changed to diagnostic in elective review later by the senior experienced cytopathologist.…”

Section: Discussionsupporting

confidence: 59%

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

Mehta

Aurangabadbadwalla

Singla

et al. 2019

Clinical Respiratory J

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Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) provides a high diagnostic yield in lung cancer, but the yield for benign conditions and lymphoma is lower. The material obtained by EBUS‐TBNA is limited by the lack of histopathological samples in some cases. The current ‘expanded’ aims of mediastinal lymph node (MLN) sampling are both an accurate diagnosis and adequate material for ‘targeted’ processing in malignant and benign disease. The sample obtained with the 21/22G EBUS needle may not be sufficient in all situations. Objectives The aim of the study was to evaluate the role of a novel technique for EBUS‐guided MLN forceps biopsy (EBUS‐TBFB) when EBUS‐TBNA with rapid on‐site‐evaluation (ROSE) failed to provide a diagnosis. In addition, the technical aspects and safety of EBUS‐TBFB were studied. Methods About 30 consecutive patients with enlarged MLN, with a negative EBUS‐TBNA ROSE were included. EBUS‐TBFB was done by the method described below. The histopathology and complications were recorded. Results Adequate samples for analysis were obtained in all the patients with both EBUS‐TBNA and EBUS‐TBFB. In patients with a non‐diagnostic EBUS‐ROSE, EBUS‐TBFB led to positive diagnostic results in an additional 8/30 patients (27%). Mild bleeding was noted in two patients who underwent EBUS‐TBFB, which resolved with conservative management. The procedure was safe with no major complications. Conclusion In patients with a negative EBUS‐ROSE, EBUS‐TBFB using this technique is safe and augments the diagnostic yield. EBUS‐TBFB adds to the armamentarium of EBUS, especially in benign aetiologies of MLN enlargement.

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Section: Discussionsupporting

confidence: 59%

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

Mehta

Aurangabadbadwalla

Singla

et al. 2019

Clinical Respiratory J

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“…Furthermore, a granulomatous reaction in mediastinal LNs is not an uncommon finding in cancer patients because it may be related to a tumor‐induced hypersensitivity reaction . Other causes of granulomatous inflammation, such as subclinical sarcoidosis, should also be considered in the differential diagnosis . Our finding of granulomatous inflammation in cancer patients is consistent with other studies finding that granulomatous inflammation in hilar or mediastinal LNs is one of several causes of PET positivity …”

Section: Discussionsupporting

confidence: 90%

“…Under the guidance of an ultrasound probe, EBUS‐TBNA can target a suspicious mediastinal LN and obtain tissue samples for morphological evaluation . EBUS‐TBNA demonstrates much higher sensitivity and specificity than conventional transbronchial needle aspiration and/or other biopsy procedures for the assessment of mediastinal and hilar LNs …”

Section: Introductionmentioning

confidence: 99%

The critical role of EBUS‐TBNA cytology in the staging of mediastinal lymph nodes in lung cancer patients: A correlation study with positron emission tomography findings

Lilo

Allison

Younes

et al. 2017

Cancer Cytopathology

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BACKGROUND:The sensitivity and specificity of positron emission tomography (PET) have been significantly improved for the identification of malignancies in recent years; however, it is still necessary to confirm PET findings in a lymph node (LN) by direct tissue sampling. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the most commonly used approach for diagnosing and staging mediastinal LNs, particularly in lung cancer patients with locally advanced disease. Despite this fact, evidence-based studies of EBUS-TBNA cytology and PET findings are still suboptimal. METHODS:The electronic database at the Johns Hopkins Medical Institutions and the pathology archives were searched to identify patients with mediastinal lymphadenopathy who had both EBUS-TBNA mediastinal LN sampling and a PET scan over a 14-month period. Patients suspected of having lung cancer and patients with a history of lung cancer were included in this study. Cytological diagnoses and follow-up surgical LN diagnoses were reviewed and correlated with PET scan findings. RESULTS: A total of 140 LNs from 79 patients, including 86 PET-positive LNs and 54 PET-negative LNs, were included. The most frequently sampled LNs were 4R and 7. The average size of PET-positive and PET-negative LNs was 1.2 and 1.6 cm, respectively. Among PET-positive LNs, 41.9% were malignant, 41.9% showed reactive changes or granulomatous inflammation, and 9.3% were nondiagnostic by EBUS-TBNA. However, among PET-negative LNs, 74.1% showed reactive changes or granulomatous inflammation, 7.4% were malignant, and 18.5% were nondiagnostic by EBUS-TBNA. CONCLUSIONS:The data demonstrate that EBUS-TBNA cytology improves the diagnostic accuracy of mediastinal LNs and clinical staging. Furthermore, EBUS-TBNA may identify additional malignant LNs (7.4%), and this highlights the risk for false-negative findings with PET scanning in isolation. Cancer Cytopathol 2017;125:717-25. V C 2017 American Cancer Society.KEY WORDS: endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA); fine-needle aspiration (FNA) cytology; lung cancer staging; mediastinal lymphadenopathy; positron emission tomography (PET) scan.

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“…Different from our current study, the cumulative yield per lymph node was not analyzed in the study by Sun et al [21], as the number of needle passes per lymph node was not precisely defined. A few investigators have suggested that the use of EBUS-TBNA for multiple lymph nodes rather than a single lymph node increases the diagnostic yield [6, 22], but this remains controversial [21, 23]. Our study indicated no difference in diagnostic yield between 1 and 2 lymph nodes.…”

Section: Discussionmentioning

confidence: 41%

“…Some investigators have assessed the number of passes or lymph nodes required as a secondary endpoint [5, 6, 21-23]. In an early study on the usefulness of EBUS- TBNA for diagnosing sarcoidosis, Garwood et al [5] reported a diagnostic yield of 85%, and the cumulative yield exceeded 80% at 5 passes.…”

Section: Discussionmentioning

confidence: 99%

How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study

et al. 2018

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Background: While endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used as an initial diagnostic procedure for pathological confirmation of sarcoidosis, it is unclear how many passes are required to obtain diagnostic materials. Objectives: The aim of this study was to determine the number of needle passes needed for the diagnosis of stage I/II sarcoidosis using EBUS-TBNA. Methods: At three institutions, 109 patients with suspected stage I/II sarcoidosis were recruited and underwent 6 passes of EBUS-TBNA for the main target lesion. Additional EBUS-TBNA for other lesions was permitted. The cumulative yields of needle passes for detecting noncaseating epithelioid cell granulomas were analyzed. Results: A total of 109 patients underwent EBUS-TBNA for 184 lesions. EBUS-TBNA identified specimens containing granulomas in 81 of 92 patients (88%) with a final diagnosis of sarcoidosis. The cumulative yields through the first, second, third, fourth, fifth, and sixth passes for the main target lesion were 63, 75, 82, 85, 86 and 88%, respectively. In the 55 patients that underwent EBUS-TBNA for multiple lesions, the cumulative yields of 2 passes per lesion for 2 lesions (total of 4 passes) and of 4 passes for single lesions were 86 and 84%, respectively (p = 1.00). Conclusions: If rapid on-site cytological evaluation is not available, we recommend at least 4 passes per patient for either single or multiple lesions with EBUS-TBNA for pathological diagnosis of stage I/II sarcoidosis.

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Yield of EBUS-TBNA for the diagnosis of sarcoidosis: impact of operator and cytopathologist experience

Cited by 56 publications

References 22 publications

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

The critical role of EBUS‐TBNA cytology in the staging of mediastinal lymph nodes in lung cancer patients: A correlation study with positron emission tomography findings

How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study

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