EBUS TBNA Research Articles

The Value of Rapid On-Site Evaluation during Conventional and Endobronchial Ultrasound Needle Aspiration in Diagnosis of Mediastinal Lymphadenopathy and Lung Cancer

Abstract Background ROSE EBUS-TBNA is a useful technique that has revolutionized the field of pulmonology. Developed initially for detecting metastasis in lung cancer patients, it is currently used in the diagnosis of sarcoidosis, tuberculosis (TB), and lymphoma. ROSE, which has been a game changer for the pathologists, helps to act as a guide for assessing the adequacy and accuracy of the sample and aid in rapid decision-making. Aim of the Work The aim of the study was to evaluate the value of ROSE during EBUS-TBNA and C.TBNA in the diagnosis of mediastinal lymphadenopathy and lung cancer. Patients and Methods Our study was a prospective study where we studied 60 cases were divided into two equal groups ROSE group and Non-ROSE group underwent either Conventional TBNA or EBUS TBNA Results The total diagnostic yield of Conventional and EBUS TBNA in both groups were 83.3% (50/60 cases). 28 cases (46.7%) positive for malignancy, 22 cases (36.6%) were positive for benign lesion, and 10 cases (16.6%) were not conclusive. Regarding diagnostic accuracy, it was higher in ROSE group than non-ROSE group (100% in ROSE group vs. 66.7% in non-ROSE group) Conclusion ROSE during Conventional or EBUS-TBNA improve diagnostic accuracy of mediastinal lesions by excluding suspicious or nondiagnostic specimens and can reduce unnecessary punctures or eliminate the need for additional bronchoscopic procedures when reaching to preliminary diagnosis

Role of EBUS in lymphoma presenting as superior vena cava syndrome: bronchoscopic and sonographic findings: a case report

BackgroundThe clinical description of superior vena cava syndrome has been widely studied; however, there is limited information on bronchoscopic findings in clinical practice.Case presentationA 57-year-old man presented with facial and neck swelling and pedal edema of 6 months duration. Computed tomography showed mediastinal lesions in the right paratracheal stations with thrombosis of the right internal jugular vein and superior vena cava (SVC). Without establishing a diagnosis, he was started on oral steroids elsewhere and his symptoms progressed. He did not receive anticoagulation therapy. Bronchoscopy showed edematous supraglottic and glottic regions with hyperemia of the airway mucosa. Endobronchial Ultrasonography revealed a mediastinal mass of heterogeneous echotexture in the lower right paratracheal region, with mediastinal collateral blood vessels. He underwent EBUS-guided aspiration cytology and intranodal forceps biopsy, which confirmed the diagnosis of non-Hodgkin’s.ConclusionIn cases with an unconfirmed diagnosis of lymphoma, it is prudent to refrain from administering glucocorticoids, as these medications can exhibit lympholytic properties and may hinder the diagnostic process. Due to extensive collateral formation in superior vena cava syndrome, utilizing Doppler during endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) can identify numerous mediastinal collateral vessels, thus minimizing the risk of bleeding.

Rapid Onsite Evaluation: A Prospective Observational Study of Endobronchial Ultrasound-Guided Transbronchial Needle Aspirates to Expedite Diagnosis.

Biomedical scientists (BMS) can report sample adequacy during EBUS TBNA using rapid on-site evaluation (ROSE). Despite being able to report exfoliative samples such as pleural fluid cytology and bronchial washings, they are usually not permitted to offer a preliminary diagnostic impression of EBUS TBNA samples. Experienced biomedical scientists can provide a reliable diagnostic impression during ROSE for EBUS samples, with sensitivity and specificity comparable to cytopathologist reporting. This work represents an advance in biomedical science because it provides evidence a BMS can safely and accurately provide a real time cytopathological impression from EBUS TBNA sampling, which could positively impact patient pathways.

Discrepancies in tumor mutation burden reporting from sequential endobronchial ultrasound transbronchial needle aspiration samples within single lymph node stations - brief report.

Tumour Mutation Burden (TMB) is a potential biomarker for immune cancer therapies. Here we investigated parameters that might affect TMB using duplicate cytology smears obtained from endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA)-sampled malignant lymph nodes. Individual Diff-Quik cytology smears were prepared for each needle pass. DNA extracted from each smear underwent sequencing using large gene panel (TruSight Oncology 500 (TSO500 - Illumina)). TMB was estimated using the TSO500 Local App v. 2.0 (Illumina). Twenty patients had two or more Diff-Quik smears (total 45 smears) which passed sequencing quality control. Average smear TMB was 8.7 ± 5.0 mutations per megabase (Mb). Sixteen of the 20 patients had paired samples with minimal differences in TMB score (average difference 1.3 ± 0.85). Paired samples from 13 patients had concordant TMB (scores below or above a threshold of 10 mutations/Mb). Markedly discrepant TMB was observed in four cases, with an average difference of 11.3 ± 2.7 mutations/Mb. Factors affecting TMB calling included sample tumour content, the amount of DNA used in sequencing, and bone fide heterogeneity of node tumour between paired samples. TMB assessment is feasible from EBUS-TBNA smears from a single needle pass. Repeated samples of a lymph node station have minimal variation in TMB in most cases. However, this novel data shows how tumour content and minor change in site of node sampling can impact TMB. Further study is needed on whether all node aspirates should be combined in 1 sample, or whether testing independent nodes using smears is needed.

Life threating onset of Cardiac Sarcoidosis with mediastinal involvement.

We have described a clinical case with atypical onset of sarcoidosis. A young patient presented to the emergency room with acute heart failure and severe cardiac dysfunction simulating dilated cardiomyopathy or severe myocarditis. Hypoxic respiratory failure refractory to oxygen therapy was treated with steroids. The diagnosis was made by a multidisciplinary team who decided to perform EndoBronchial UltraSound-guided TransBronchial Needle Aspiration (EBUS TBNA) in addition to a cardiac MRI. The result was to obtain, in this case, a prompt therapeutic response in order to preserve the patient cardiac function.

Efficacy of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal and hilar lesions.

Mediastinal and hilar lesions may be benign or malignant. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis of these lesions as it is both minimally invasive and safe. To investigate the clinical efficacy of EBUS-TBNA in the diagnosis and differential diagnosis of mediastinal and hilar lesions. A retrospective observational study was undertaken to investigate patients diagnosed with mediastinal and hilar lymphadenopathy based on imaging at our hospital from 2020 to 2021. After evaluation, EBUS TBNA was used and data including the puncture site, postoperative pathology, and complications were recorded. Data from 137 patients were included in the study, of which 135 underwent successful EBUS TBNA. A total of 149 lymph node punctures were performed, of which 90 punctures identified malignant lesions. The most common malignancies were small-cell lung carcinoma, adenocarcinoma, and squamous cell carcinoma. Forty-one benign lesions were identified, resulting from sarcoidosis, tuberculosis, and reactive lymphadenitis, amongst others. Follow-up findings showed that 4 cases were malignant tumors, with 1 case of pulmonary tuberculosis and 1 case of sarcoidosis). Four specimens where lymph node puncture was insufficient were subsequently confirmed by other means. The sensitivity of EBUS TBNA for malignant lesions, tuberculosis and sarcoidosis in mediastinal and hilar lesions was 94.7%, 71.4%, and 93.3%, respectively. Similarly, the negative predictive values (NPV) were 88.9%, 98.5%, and 99.2%, and the accuracy was 96.3%, 98.5%, and 99.3%. EBUS TBNA is an effective and feasible approach for the diagnosis of mediastinal and hilar lesions that is minimally invasive and safe.

Whole Genome Sequencing in Advanced Lung Cancer can be Performed Using Diff-Quik Cytology Smears Derived from Endobronchial Ultrasound, Transbronchial Needle Aspiration (EBUS TBNA)

IntroductionMaximising alternative sample types for genomics in advanced lung cancer is important because bronchoscopic samples may sometimes be insufficient for this purpose. Further, the clinical applications of comprehensive molecular analysis such as whole genome sequencing (WGS) are rapidly developing. Diff-Quik cytology smears from EBUS TBNA is an alternative source of DNA, but its feasibility for WGS has not been previously demonstrated.MethodsDiff-Quik smears were collected along with research cell pellets.ResultsTumour content of smears were compared to research cell pellets from 42 patients, which showed good correlation (Spearman correlation 0.85, P < 0.0001). A subset of eight smears underwent WGS, which presented similar mutation profiles to WGS of the matched cell pellet. DNA yield was predicted using a regression equation of the smears cytology features, which correctly predicted DNA yield > 1500 ng in 7 out of 8 smears.ConclusionsWGS of commonly collected Diff-Quik slides is feasible and their DNA yield can be predicted.

Evaluating Diff‐Quik cytology smears for large‐panel mutation testing in lung cancer—Predicting DNA content and success with low‐malignant‐cellularity samples

Cytology smears are commonly collected during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) procedures but are rarely used for molecular testing. Studies are needed to demonstrate their great potential, in particular for the prediction of malignant cell DNA content and for utility in molecular diagnostics using large gene panels. A prospective study was performed on samples from 66 patients with malignant lymph nodes who underwent EBUS TBNA. All patients had air-dried, Diff-Quik cytology smears and formalin-fixed, paraffin-embedded cell blocks collected for cytopathology and molecular testing. One hundred eighty-five smears were evaluated by microscopy to estimate malignant cell percentage and abundance and to calculate smear size and were subjected to DNA extraction. DNA from 56 smears from 27 patients was sequenced with the TruSight Oncology 500 assay (Illumina). Each microscopy parameter had a significant effect on the DNA yield. An algorithm was developed that predicted a >50-ng DNA yield of a smear with an area under the curve of 0.86. Fifty DNA samples (89%) with varying malignant yields were successfully sequenced. Low-malignant-cell content (<25%) and smear area (<15%) were the main reasons for failure. All standard-of-care mutations were detected in replicate smears from individual patients, regardless of malignant cell content. Tier 1/2 mutations were discovered in two cases where standard-of-care specimens were inadequate for sequencing. Smears were scored for tumor mutation burden. Microscopy of Diff-Quik smears can triage samples for comprehensive panel sequencing, which highlights smears as an excellent alternative to traditional testing with cell blocks.

Clinicopathological Evaluation of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA) in Diagnosis of Mediastinal Lesions

Background: The diagnosis of mediastinal lesions is not easy. Special techniques are indicated for evaluation and confirmation of diagnosis. Objectives: The aim of the study is the endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) is an important tool for clinicopathological evaluation as well as diagnosis of different mediastinal lesions. Materials and Methods: It was an observational study. EBUS-TBNA was done in eighty six patients. All these individuals have mediastinal pathology. Endobronchial aspiration was done from the lesions seen by ultrasonography and its cytomorphological analysis was done. Tissue morphology was also examined from cell block preparation. Immediate post procedure complications were monitored. Results: In the study, total eighty six (86) cases with adequate material were included. Fifty one (51) cases were granulomatous lymphadenitis, necrotizing granulomatous lymphadenitis were identified in 20 cases and 28 had non-necrotizing granulomas and only three cases are granuloma with suppuration. Tuberculosis was diagnosed in 23 patients (26.7% of granulomatous) and sarcoidosis was found in twenty eight cases (32.6% of granulomatous). Seventeen (19.8%) patients had malignant disorders. Out of 17 cases of malignancy, adenocarcinoma was the predominant (07cases), five cases were non-small cell carcinoma, small cell carcinoma was four cases and non-Hodgkin lymphoma was only one. Eighteen cases (20.9%) had cytological features of reactive lymphadenitis. During procedure no complications developed. Conclusions: For diagnosis of different mediastinal pathology and collection of adequate cytological as well as tissue material (cell block), EBUS TBNA is an important diagnostic procedure with minimal invasion.

Spectrum of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) in the Diagnosis of Mediastinal Lymphadenopathy: An Experience at Tertiary Care Center

Introduction: Endobronchial Ultrasound-guided TransbronchialNeedle Aspiration (EBUS TBNA) is a new minimally invasivetechnique presently used for evaluating mediastinal lesions. Ithas also proved to be valuable for the lymphnode (LN) stagingof lung cancer,as well as for the primary diagnosis of unclearmediastinal lesionsMaterial and Methods: EBUS-FNAs from mediastinal lymphnodes were retrospectively reviewed from January 2020 toJanuary 2022 and their findings were correlated with thehistology.Results: A total of 60 cases were obtained. Out of which, 3cases were non diagnostic, and 57 cases were diagnostic.Three cases were reactive hyperplasia, seventeen weregranulomatous lymphadenitis and thirty-seven cases werepositive for malignant cells. Out of the thirty-seven positivecases for malignant cells, a biopsy was received in 29 of themand 27 cases showed positive histological correlation.Conclusion: EBUS-FNA is a rapid, safe, and effective methodthat can be used routinely to diagnose mediastinal lesions.

Prognostic Impact of EBUS TBNA for Lung Adenocarcinoma Patients with Postoperative Recurrences.

Background: The aim of this study was to verify the importance and the timing of endobronchial ultrasound with transbronchial biopsy (EBUS TBNA) among lung adenocarcinoma patients after radical resection. Methods: We retrospectively reviewed consecutive patients with non-small cell lung cancer (NSCLC) who had ever received radical resection from January 2002 to December 2021. The patients were divided into two groups, with and without EBUS TBNA, for diagnosis or staging. Results: Of 2018 patients with NSCLC, after surgical resection of lung tumors, there were 232 with recurrences. Under multivariate Cox regression analysis, patients with recurrences who received EBUS TBNA had a statistically higher mean maximum standardized uptake value (SUVmax) (hazard ratio (HR) = 1.115, confidence interval (CI) = 1.004–1.238, p = 0.042) and better survival (HR = 5.966, CI = 1.473–24.167, p = 0.012). Although KM survival analysis showed no statistically significant difference between groups with and without EBUS TBNA (p = 0.072) of lung adenocarcinoma patients with recurrences, patients with mutated epidermal growth factor receptor (EGFR) showed significantly better survival than wild-type EGFR (p = 0.007). Conclusions: The clinical practice of EBUS TBNA is not only for diagnosis, but also for nodal staging. We found that lung adenocarcinoma patients with recurrences who received EBUS TBNA had better overall survival. Therefore, EBUS TBNA is a reliable and feasible tool that could be used in lung adenocarcinoma patients with recurrences for early diagnosis and for adequate tissue specimens for further molecular analysis.

Prospective Optimization of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Lymph Node Assessment for Lung Cancer: Three Needle Agitations Are Noninferior to 10 Agitations for Adequate Tumor Cell and DNA Yield

IntroductionEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) is an important means of obtaining a tissue for advanced lung cancer. Optimizing the EBUS TBNA needling technique is important to maintain procedural simplicity and maximize sample quality for emerging molecular diagnostics. MethodsWe prospectively explored three versus 10 agitations of the needle in sequential passes into the lymph node using separate needles. Resulting Diff-Quik cytology smears were quantitatively assessed using microscopic (tumor cell cellularity, abundance scores, erythrocyte contamination) and DNA yields. Microscopy was reported by two cytopathologists, and an inter-rater assessment was made by four additional cytopathologists. ResultsIn 86 patients confirmed as having malignant disease by EBUS TBNA (45 males, 41 females), a mean of 5.3 smears were made per patient with a total of 459 smears scored by pathologists and 168 paired smears extracted for DNA. There was no significant difference between three versus 10 agitations for smear cellularity (p = 0.44), DNA yield (p = 0.84), or DNA integrity (p = 0.20), but there was significantly less contamination by erythrocytes from three agitations (chi-square p = 0.008). There was significantly more DNA in the first pass into the node using three agitations than with other passes and with 10 agitations (pass × agitations interaction, p = 0.031). Reviewing pathologists correctly classified smears as more than or equal to 25% cellularity 86.3% of the time (κ = 0.63 [95% confidence interval: 0.55–0.71]). ConclusionsThree agitations are noninferior to 10 agitations for overall abundance of malignant cells and DNA content on smears. A smear with adequate DNA for panel sequencing could almost always be made with the first needle pass using three agitations.

Handling and standardization of EBUS needle aspiration in NSCLC patients: The value of the cell block, a monoinstitutional experience.

BackgroundLung cancer is the main cause of cancer‐related death worldwide, and 85% of all lung tumors are non‐small cell lung cancers (NSCLC). More than 60% of all lung tumors are diagnosed at an advanced stage, leading to poor prognosis. Given the growing demand for NSCLC profiling for selection of the most appropriate therapy, the acquisition of adequate tumor samples has become increasingly crucial, mostly in advanced NSCLC patients due to old age and/or comorbidities. Being a mini‐invasive sampling technique, endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) represents a valuable alternative to traditional transthoracic or surgical sampling in these patients, and perfoming cell block (CB) could be crucial to maximize the potential biological information. The aim of this study is to describe a monoinstitutional interprofessional experience in handling EBUS‐TBNA and CB in 464 patients.METHODSWe retrospectively collected all the consecutive CBs obtained from EBUS TBNA performed between 2014 and 2021 on the lung lesions or mediastinal lymph nodes. All the CBs were handled in a standardized method.RESULTSA total of 95.5% (448/464 samples) of adequacy for site and 92.6% (430/464) of adequacy for diagnosis were observed. Moreover, in the adenocarcinoma histotype, ALK, ROS1 and tumor proportion score (TPS) PD‐L1 assessment by IHC was possible in 96% (140/146) of cases, and molecular profile was obtained in 93.8% (137/146) of cases. In the squamous cell carcinoma histotype, TPS PD‐L1 assessment was possible in 81% (13/16) of cases. All four CB results obtained from carcinoma NOS were adequate for ALK, ROS1 and PD‐L1 assessment and molecular profiling. All 39 metastatic samples from extra‐pulmonary primary were adequate for immunohistochemical characterization and molecular profiling. Finally, reporting of the tumor sample adequacy to the clinicians took a median time of about 30 h (range: 24–80 h).ConclusionCareful cytological smear management together with the handling and standardization of CB obtained from EBUS‐TBNA could represent an effective method to increase the adequacy of the tumor specimen for both diagnosis and molecular profile.

129P Regulatory dendritic cells correlate with an altered T cell distribution and regulatory T cell phenotype in metastatic lymph nodes of NSCLC patients

Dendritic cells (DCs) are considered to be the most important professional population of antigen-presenting cells and play a crucial role in the activation of the immune system. However, the proper function of DCs is altered by the tumor microenvironment (TME). Despite the progress in anticancer immunotherapy, there are still many unresolved issues. Among them, the immunomodulatory properties of DCs in lung cancer are of interest. The aim of the study was to analyze the PD-1+ PD-L1+ CD80- DCs subset, described as regulatory dendritic cells (DCregs), and to investigate correlations between the presence of DCregs and changes in T cell frequencies and immunomodulatory molecules in metastatic and non-metastatic lymph nodes (LNs) aspirates of NSCLC patients. LNs aspirates were obtained during the diagnostic EBUS TBNA procedure of 30 NSCLC patients. DCregs and T cell characteristics were determined by multiparameter flow cytometry. We noticed a higher percentage of DCregs in the metastatic than in the non-metastatic LNs (22.5% vs. 3.1%). DCs cells show increased expression of PD-1 and PD-L1. Additionally, metastatic LNs contained a lower percentage of CD4 T cells, whereas the percentage of CD8 T cells and Tregs was increased as compared to non-metastatic LNs. Surprisingly, the percentage of DCregs positively correlated with the percentage of PD-1+ T cells, Tregs and CD45RO+ Tregs. Our results confirm the utility of flow cytometric analysis of EBUS/TBNA samples to assess the interaction between immune cells in TME. DCregs strongly associates with an altered T cell distribution and immunosuppressive phenotype in metastatic LNs of NSCLC patients. It can be assumed that DCregs are involved in the suppression of anti-tumor response, which could be of importance for the response upon immunotherapy.

Effectiveness Of Clinical Parameters And Laboratory Values In Predicting The Clinical Course of Sarcoidosis

Aim: The natural course of sarcoidosis is heterogeneous. There is no clear marker that can predict the course of this disease and its characteristics over months/years. We aimed to analyze our patients' data to identify a prediction parameter at admission.Methods: The patients with sarcoidosis and followed-up between 01/01/2015 and 31/12/2020 comprised the study group. The patients were staged by a Scadding staging system. Improvement or deterioration in at least two of the clinical-laboratory-radiological parameters indicates regression, stable disease, progression, or relapse of sarcoidosis.Results: The study group comprised 4 cases (6.9%) defined as stage 0; 15 cases (25.86%) as stage 1; 39 cases (67.24%) were defined as stage 2. The mean age at diagnosis was 40.84±13.56 in stage 0 + stage 1 group, while it was 48.05±13.36 in the stage 2 group (p=0.06). 74.1% of the cases were women. The female/male ratio was found at 2.86. 57 out of 58 cases had a pathological diagnosis (EBUS TBNA). While PFTs values and DLCO were significantly lower at advanced stages but the same statistical significance was not identified between these values and the clinical course of the disease. As a result of the multivariate analysis, it was observed that only the presence of chest pain at admission affected the progression of the disease in the follow-up period.Conclusion: Sarcoidosis is a multi-systemic disease and there is no clear finding for predicting the poor prognosis of the disease. We conclude that chest pain symptom at admission is valuable predictive finding and can be used as a clue for the progression at follow-up.

Potential application of cryobiopsy for histo-molecular characterization of mediastinal lymph nodes in patients with thoracic malignancies: a case presentation series and implications for future developments

BackgroundThe management of non-small cell lung cancer (NSCLC) has become increasingly complex due to the evolution of personalized medicine approaches. Such approaches are characterized by the necessity of adequate tumor samples; hence, improved biopsy techniques are needed. Transbronchial lung cryobiopsy is a novel endoscopic procedure designed to collect peripheral pulmonary tissue, and it is currently employed in interstitial lung diseases. The use of this technique in oncology might result in improved mediastinum staging and molecular characterizations; however, available data involving the use of a cryoprobe on mediastinal lymph nodes are still limited.Case presentationHere we present a series of five consecutive patients who underwent endoscopic assessment of mediastinal lymph nodes for oncologic reasons. All patients were subjected both to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) and cryobiopsy of mediastinal lymph nodes during the same procedure, and no complications were observed. In three of the reported cases, both cryobiopsy and cell block from EBUS TBNA were positive, while in one case cryobiopsy was not diagnostic and EBUS TBNA was negative; moreover, one case showed discordance between the procedures, as cryobiopsy was negative and cell block obtained from multiple stations was diagnostic for small cell lung cancer. In one case involving a patient treated for lymphoma, cryobiopsy provided more complete histologic characterization, and in another case involving a patient affected by NSCLC cryobiopsy provided more material for molecular analyses.ConclusionThis case presentation series suggests that cryobiopsy, which has been generally used on peripheral lung lesions so far, is a feasible and safe approach for diagnosis and staging of mediastinal lymph nodal involvement, especially when station 7 is involved. Compared to EBUS TBNA, cryobiopsy might provide more adequate histological samples, with a possible impact on molecular characterizations and, therefore, therapeutic decisions. However, the learning curve of the procedure has not to be understated and optimal protocols for implementing this technique are needed. In our opinion, further studies designed to integrate the routine use of cryobiopsy in current practice for solid and eventually hematologic tumors with mediastinal lymph node involvement are warranted.

Comparison of Sample Adequacy and Diagnostic Yield of the 21-G and 25-G EBUS TBNA Needles.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) of mediastinal lymphadenopathy has been shown to be equivalent and possibly even superior to mediastinoscopy. Since the original dedicated 22-G aspiration needle, 21-G, 25-G, and recently 19-G needles have been introduced. Smaller needles may be more flexible and adept at accessing more difficult nodes, and may have less blood contamination compared with larger needles. This is a prospective observational study of 50 consecutive patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration with a 21-G needle and a 25-G needle for a total of 100 biopsies. The study slides were examined by a dedicated lung cytopathologist, who was blinded to the needle size used for each slide. Demographic data, and lymph node size were recorded. Comparisons between the 2 needles with regards to sample adequacy and diagnostic yield was performed using the McNemar test for dichotomous variables and marginal homogeneity test for nondichotomous variables since samples were related. The majority of lymph nodes (96%) were at least >1 cm. Adequate specimens were obtained in 78% of cases with the 21-G needle and 86% of cases with 25-G needle (P-value=0.424). The overall diagnostic yield was 74% and 80% with the 21-G needle and 25-G needle, respectively (P-value=0.607). Our study demonstrates that the there is no difference in terms of specimen adequacy and diagnostic yield when the 25-G needle is compared with the 21-G needle.

Utility of needle core specimen in improving the diagnostic yield of EBUS TBNA

OBJECTIVES EBUS-TBNA has become a highly sensitive, minimally invasive, outpatient procedure for the assessment of mediastinal adenopathy. The standard cytological analysis is the preferred modality for diagnosis from EBUS-TBNA and diagnostic value of needle core specimen is less studied. The current study fills the gap by comparing utility of EBUS needle-core specimen histology to EBUS FNA cytology. METHODS 196 patients who underwent EBUS-TBNA between January 2017 and March 2020 in a single centre were included in the study. Diagnostic yields of two specimen-processing techniques, fixed slides (cytology) and needle core samples (histology) were compared. RESULTS The composite diagnostic index had found disease etiology in 176 of the 196 patients. EBUS cytology specimens were diagnostic in 125 cases (63.77%) and needle core specimen histology in 154 cases (78.57%). Combining both increased the yield to 166 (84.69%). Out of the total 186 in which both samples were available, the additional yield of histology samples over cytology samples was 19.351% whereas, that of cytology over histology was only 5.37%. Evaluation of needle core specimen histology is statistically significant over smear cytology in terms of sensitivity, specificity and diagnostic accuracy (p&lt;0.05). Also, combined evaluation of cytology and histology improved the negative predictive value of the test than both considered separate (p&lt;0.05). CONCLUSION Procuring needle core specimens for histological analysis improves the overall diagnostic yield of EBUS-TBNA than cytology alone. EBUS TBNA technique has yielded tissue samples adequate enough to perform molecular profiling for targeted therapies in lung cancer and microbiological investigations related to tuberculosis. Keywords: Endobronchial ultrasound, Mediastinal adenopathy, EBUS needle core biopsy, Cytology

Anaesthetic management of endobronchial ultrasound guided trans bronchial needle aspiration: Our experience with laryngeal mask airway

Introduction: Endobronchial Ultrasound Guided Trans bronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic modality for evaluating intra thoracic lymph nodes, becoming one of the important tool in the armamentarium of pulmonologists. The size of the fiberscope and sharing of the airway with the bronchoscopist poses unique challenges to the anesthesiologist. In light of these developments it is important to develop an office based anesthesia technique for this relatively new procedure. Hence we did this descriptive cohort study. Aim: To describe the accuracy and anaesthetic management of EBUS-TBNA as a day care procedure, done with general anesthesia (GA). Materials and Methods: Data was collected from January 2017 to December 2017 at our institute from patients who underwent EBUS-TBNA under GA using second generation laryngeal mask airway (LMA). Specifically, hemodynamic status, Oxygen saturation, duration of the procedure, diagnostic yield and complications of the procedure were recorded. Results: 23 patients underwent EBUS-TBNA under GA. All patients were found to be hemodynamically stable with fluctuations in blood pressure and heart rate being less than 20% from the baseline with no episodes of desaturation .The average number of biopsies taken is 3.3, with average duration of the procedure being 67.0±17.6 (mean±SD) minutes. The incidence of post procedural complications like cough and sore throat were minimal. Successful diagnostic yield was found in all cases with no incidence of recall of the procedure. Conclusion: The performance of EBUS-TBNA under general anesthesia with LMA provides great hemodynamic stability and adequate ventilation in a shared airway. It demonstrates excellent diagnostic accuracy. It provides comfort to the patient and the good examination conditions to the bronchoscopist. Clinical Significance: Use of P-LMA solves the dilemma of managing ventilation during EBUS TBNA without affecting the diagnostic yield of the pr

OC-0227: Impact of FDG-PET/CT and EBUS TBNA: Possibilities and adaptations for precise radiotherapy in NSCLC

OC-0227: Impact of FDG-PET/CT and EBUS TBNA: Possibilities and adaptations for precise radiotherapy in NSCLC