The role of endobronchial ultrasound-guided transbronchial needle aspiration liquid-based cytology in the diagnosis of mediastinal lymphadenopathy.

Chuancai Xu,Jian'An Huang,Chongjun Ni,Junhong Jiang,Lingyan Qin,Wei Lei

doi:10.1002/dc.24374

Abstract

BackgroundEndobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a minimally invasive, reliable technique for sampling mediastinal lymph nodes (LNs). Liquid‐based cytology (LBC) is widely used for cervical cancer screening because it provides reliable and feasible results. The present study aimed to evaluate effectiveness of the combination of EBUS‐TBNA and LBC in the diagnosis of mediastinal lymphadenopathy.MethodsA total of 602 LNs that were retrospectively analyzed were sampled in 442 patients who underwent EBUS‐TBNA between January 2014 and December 2016. The histopathological result of TBNA tissue or cell blocks was considered as the gold standard to evaluate diagnostic utility of LBC and conventional smears (CS) for the diagnosis of mediastinal lymphadenopathy.ResultsOf the 602 LNs, 265 were mediastinal LN metastases from lung cancer, four were lymphoma, and 333 were benign. The sensitivity of LBC and CS in the diagnosis of mediastinal LN metastases from lung cancer was 72.8% and 63%, respectively, and the specificity was 98.5% and 97%, respectively. The positive predictive values for LBC and CS were 97.5% and 94.4%, respectively, whereas the negative predictive values were 82.2% and 76.9%, respectively. The accuracy of LBC and CS was 88% and 83.7%, respectively. The diagnostic value of LBC was significantly higher than that of CS (P = .001).ConclusionsThe combination of EBUS‐TBNA and LBC is a highly reliable and feasible procedure that optimizes diagnostic utility for the diagnosis of lung cancer and mediastinal LN staging.

Highlights

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a first-line, minimally invasive procedure for the diagnosis of patients with mediastinal lymphadenopathy.[1,2] Under guidance of an ultrasound probe, mediastinal lymph node (LN) biopsies can be performed effectively with TBNA
Over the past few years, the Liquid-based cytology (LBC) techniques ThinPrep and SurePath have been extensively implemented for the cytological diagnosis of nongynecological specimens,[11] LBC has been widely used for respiratory tract specimens.[7]
Kobayashi et al analyzed the difference in cell number, cell morphology, and slide background between conventional smears (CS) and LBC samples obtained by TBNA, and concluded that LBC could be reliably and routinely used in specimens obtained via TBNA.[13]

Summary

Introduction

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a first-line, minimally invasive procedure for the diagnosis of patients with mediastinal lymphadenopathy.[1,2] Under guidance of an ultrasound probe, mediastinal lymph node (LN) biopsies can be performed effectively with TBNA. The present study aimed to retrospectively evaluate diagnostic utility of EBUS-TBNA combined with LBC in mediastinal lymphadenopathy.

Results

Conclusion