EBUS-TBNA in the diagnosis of haematological malignancies; overcoming the challenge

Abstract

Introduction: EBUS-TBNA has been embraced as a breakthrough diagnostic tool in the diagnosis and staging of lung cancer, however its role in diagnosing haematological malignancies remains controversial and it is currently not adopted by the current guidelines. Aim: To investigate the use of EBUS-TBNA in the diagnosis and subtyping of haematological malignancies. Materials and Methods: Multicentre retrospective study in patients who underwent EBUS-TBNA in three tertiary UK centres between 2008-2013. We investigated the diagnostic accuracy, sensitivity and prevention of mediastinoscopies/surgical biopsies in 24 new /suspected relapse cases with mediastinal haematological malignancy. Results: Our study group consisted of 10 females and 14 males (mean age 55.5 years). First time diagnosis was correctly set in 11/15 (73.3%) new lymphomas and 5/8 (62.5%) recurrencies and 1 patient was diagnosed with TB. Both cytology and histology samples were obtained in 22/24 cases and immunohistochemistry was performed in 14/24 cases allowing accurate subtyping of the disease. Mediastinoscopies/further diagnostic surgical biopsies were prevented in 17/24 patients. Sensitivity and specificity of EBUS TBNA in primary and relapsing haematological malignancy was 74% and 100% respectively. Conclusion: EBUS-TBNA can be successfully and safely used in the diagnosis of new and recurrent mediastinal haematological malignancies and can satisfactorily prevent further invasive diagnostic procedures.