False positive endobronchial ultrasound-guided real-time transbronchial needle aspiration secondary to bronchial carcinoma in situ at the point of puncture: a case report

José Sanz-Santos,María Llatjós,Pere Serra,Eduard Monsó,Julio Astudillo,Eva Castellà,Juan Ruiz-Manzano,Felipe Andreo

doi:10.1186/1749-8090-7-74

Abstract

Since the development of endobronchial ultrasound-guided real-time needle aspiration (EBUS-rt-TBNA) no false positive (FP) cases have been described. We present the first FP case for EBUS-rt-TBNA secondary to a carcinoma in situ (CIS) in the bronchial point of puncture. A 66-years-old male was referred to our Institution because of a mass in left lower lobe. The bronchoscopy did not show any endobronchial lesion. The cytology of the washing confirmed an unspecified non-small cell lung cancer. An EBUS-rt-TBNA for staging was carried out. No mediastinal nodes over 5 mm length were found but one single left hilar node at station 11 L was sampled. The cytology of the TBNA showed lymphocytes and neoplastic squamous cells. The patient underwent thoracotomy. On the surgical specimen no metastasis on any of the nodes resected were detected but a CIS on the bronchial resection margin was described. A bronchial biopsy confirmed CIS on the bronchial stump. The reported case depicts an unusual situation, we consider EBUS-rt-TBNA an accurate technique if minimal requirements are met

Highlights

Endobronchial ultrasound-guided real-time transbronchial needle aspiration (EBUS-rt-TBNA) is a relatively novel technique that has proven useful in lung cancer diagnosis and staging
We present the first FP case of EBUS-rt-TBNA
Cropp [2] and cols were the first investigators to describe a false positive in a TBNA sampling. These authors postulated that tumor cells exfoliated from bronchogenic carcinoma could be located on the cell carcinoma (SCC) stage IIa cT2aN1M0 and underwent left lower lobe lobectomy

Summary

Background

Endobronchial ultrasound-guided real-time transbronchial needle aspiration (EBUS-rt-TBNA) is a relatively novel technique that has proven useful in lung cancer diagnosis and staging. EBUS-rt-TBNA can be performed under conscious sedation in an outpatient setting. Several studies have demonstrated that EBUS-rt-TBNA is an accurate procedure alternative to surgical staging, with fewer complications and similar figures for sensitivity and specificity. We present the first FP case of EBUS-rt-TBNA. A chest x-ray was performed and a mass on left lower lobe (LLL) was detected. The thoracic CT-scan confirmed the presence of a peripheral mass on LLL (4x3 cm), without evidence of nodal enlargement (Figure 1). The bronchial washing cytology was positive for unspecified non-small cell lung cancer. The cytological examination of the smear showed the presence of lymphocytes and a few groups of neoplastic squamous cells (Figure 2a).

Discussion

Conclusions