Transbronchial Aspiration Research Articles

Diagnostic Value of EBUS-TBNA for Lung Cancer with Non-Enlarged Lymph Nodes: A Study in a Tuberculosis-Endemic Country

BackgroundIn tuberculosis (TB)-endemic areas, contrast-enhanced computed tomography (CT) and positron emission tomography (PET) findings of lung cancer patients with non-enlarged lymph nodes are frequently discrepant. Endobronchial ultrasound-guided transbronchial aspiration (EBUS-TBNA) enables real-time nodal sampling, and thereby improves nodal diagnosis accuracy. This study aimed to compare the accuracy of nodal diagnosis by using EBUS-TBNA, and PET.MethodsWe studied 43 lung cancer patients with CT-defined non-enlarged mediastinal and hilar lymph nodes and examined 78 lymph nodes using EBUS-TBNA.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 80.6%, 100%, 100%, and 85.7%, respectively. PET had low specificity (18.9%) and a low positive predictive value (44.4%). The diagnostic accuracy of EBUS-TBNA was higher than that of PET (91% vs. 47.4%; p<0.001). Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes. Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB. Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET.ConclusionIn a TB-endemic area with a condition of CT-defined non-enlarged lymph node, the negative diagnostic impact of PET limits its clinical usefulness for nodal staging; therefore, EBUS-TBNA, which facilitates direct diagnosis, is preferred.

Rapid On-site Evaluation of Transbronchial Aspirates in the Diagnosis of Hilar and Mediastinal Adenopathy: A Randomized Trial

Rapid on-site evaluation (ROSE) of transbronchial needle aspirates has long been used during flexible bronchoscopy, but its usefulness in the diagnosis of hilar and mediastinal adenopathy is controversial. The aim of the present study was to evaluate the extent to which ROSE can be valuable in patients undergoing transbronchial needle aspiration (TBNA) for the diagnosis of hilar and mediastinal adenopathy. A total of 168 consecutive patients with enlarged lymph nodes were randomized to undergo TBNA with or without ROSE. The primary outcome measure of the study was the diagnostic yield of TBNA on a per-patient basis. Secondary outcome measures included the percentage of adequate specimens on a per-lymph node basis, the number of biopsy sites on a per-patient basis, and the complication rate of bronchoscopy on a per-patient basis. We found no significant difference between the TBNA group and the ROSE group in terms of diagnostic yield (75.3% vs 78.3%, respectively; P = .64), and percentage of adequate specimens (86.5% vs 78.4%, respectively; P = .11). The median (interquartile range) number of biopsy sites was significantly lower in the ROSE group (1 [1-2] vs 2 [1-2], respectively; P = .0005). The complication rate of bronchoscopy was significantly lower in patients undergoing on-site review (6% vs 20%; P = .01), whereas the complication rate of TBNA was similar among the study groups. ROSE of transbronchial aspirates from hilar and mediastinal nodes enables avoidance of additional biopsy without loss in diagnostic yield and reduces the complication rate of bronchoscopy. ClinicalTrials.gov; No.: NCT00915330; URL: www.clinicaltrials.gov

Transbronchial and Transesophageal Fine-Needle Aspiration Using an Ultrasound Bronchoscope in Mediastinal Staging of Potentially Operable Lung Cancer

We performed this study to evaluate the role of transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer. In this prospective study, we applied transbronchial and transesophageal ultrasonography using an ultrasound bronchoscope on patients with confirmed or strongly suspected potentially operable non-small cell lung cancer. Following EBUS-TBNA, EUS-B-FNA was used for mediastinal nodes that were inaccessible or difficult to access by EBUS-TBNA. The accessibility by EBUS-TBNA and EUS-B-FNA to mediastinal nodal stations having at least one node ≥ 5 mm was also checked. In 150 patients, we performed EBUS-TBNA and EUS-B-FNA on 299 and 64 mediastinal nodal stations, respectively. Among 143 evaluable patients, EBUS-TBNA diagnosed mediastinal metastasis in 38 patients. EUS-B-FNA identified mediastinal metastasis in three additional patients. Surgery diagnosed mediastinal metastasis in four more patients. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 84.4%, 93.3%, and 95.1%, respectively. These values for the combined approach of EBUS-TBNA and EUS-B-FNA increased to 91.1%, 96.1%, and 97.2%, respectively, although the differences were not statistically significant (P = .332, P = .379, and P = .360, respectively). Among 473 mediastinal nodal stations having at least one node ≥ 5 mm that were evaluated, the proportion of accessible mediastinal nodal stations by EBUS-TBNA was 78.6%, and the proportion increased to 84.8% by combining EUS-B-FNA with EBUS-TBNA (P = .015). Following EBUS-TBNA in the mediastinal staging of potentially operable lung cancer, the accessibility to mediastinal nodal stations increased by adding EUS-B-FNA and an additional diagnostic gain might be obtained by EUS-B-FNA. clinicaltrials.gov, NCT00741247.

Diagnostic Value of Histology Compared With Cytology in Transbronchial Aspiration Samples Obtained by Histology Needle

Results from endoscopic needle aspiration [transbronchial needle aspiration (TBNA), esophageal ultrasound-guided fine needle aspiration, real-time endobronchial ultrasound] mainly rely on cytology. We performed a retrospective study to evaluate the possible advantage of obtaining histologic samples during TBNA in the diagnostic assessment of mediastinal lymph node enlargement. In a retrospective study 2 pathologists evaluated all TBNAs from patients with mediastinal lymph node enlargement in whom representative histologic and cytologic material was obtained, using only a histology needle. Cytology was reviewed before histology in a randomized, blinded fashion. Afterward, the results were related to the diagnosis made in the actual workup of the patient. A total of 50 TBNAs were reviewed. In 86% (43 of 50), both pathologists made the same diagnosis on both specimens, or a difference in cytology and/or histology specimens did not alter the eventual treatment. In 14% (7 of 50) of all TBNAs, histology revealed a diagnosis according to at least 1 pathologist, which altered patient treatment. Histologic material can reveal additional diagnostic information compared with sole cytologic examination in 14% of representative TBNA samples in patients with mediastinal lymph node enlargement. A discrepancy between cytologic and histologic TBNA results should prompt further investigation.

Rapid on-site evaluation of transbronchial aspirates: randomised comparison of two methods

The value of different staining methods for rapid analysis of transbronchial needle aspirates during bronchoscopy has not been explored. In the present study, we compared a Papanicolaou-based rapid stain, prepared by a technologist and read by a cytopathologist, and a Wright-Giemsa-based rapid stain, prepared and read by a cytopathologist alone. Gold standard was the final laboratory report issued on each aspirate. We harvested 827 aspirates from 218 target sites in 126 consecutive patients. At least one positive aspirate was found in 99 (79%) patients. In those 99 patients, 288 of 574 (50%) aspirates were positive for neoplastic (83%) or non-neoplastic (17%) disease. False-negative aspirates and target sites were more frequent with the rapid Wright-Giemsa than with the rapid Papanicolaou stain (14.2 versus 7.3%, p = 0.008, and 13.7 versus 3.6%, p = 0.021, respectively). The sensitivity of the Wright-Giemsa-based and Papanicolaou-based rapid stains for detecting diagnostic material was 93 and 100% in patients, 83.1 and 95.5% in target sites, and 72.8 and 84.9% in aspirates, respectively. Specificity was 100% for both methods in patients and target sites, and 90.4 and 95% in aspirates. We concluded that a Papanicolaou-based stain has superior yield and accuracy to a Wright-Giemsa-based stain for rapid on-site evaluation of transbronchial needle aspirates.

Transbronchial catheter aspiration compared to forceps biopsy in the diagnosis of peripheral lung cancer

ObjectiveThe usual procedure for obtaining material for histological analysis for the diagnosis of peripheral carcinoma of the lung is transbronchial forceps biopsy (TBB). Not widely spread is acquiring samples for cytological examination by transbronchial catheter aspiration (TBCA). Data were retrospectively collected to determine the diagnostic sensitivity of TBCA in comparison with TBB concerning malignancy.MethodsWe analysed the results of 51 consecutively examined patients (age 68.7 ± 8.8 yrs.) applying both methods. 48 of 51 peripheral lesions proved to be malignant, 34 of which measured > 3 cm in diameter and 14 ≤ 3 cm. Fluoroscopy provided guidance in biopsies for both techniques.ResultsThe mean diameter of the lesion was 3.7 ± 1.5 cm. We were able to establish a correct diagnosis by TBCA in 36 of 48 patients with lung cancer, and in 21 of 48 patients by TBB (75% vs. 44%, p < 0.01, chi-square-test). By combination of both methods 39 of 48 patients were correctly diagnosed. For carcinoma > 3 cm the success rate for TBCA was 76% (26/34) and for TBB 56% (19/34). For carcinoma ≤ 3 cm the success rate for TBCA was 71% (10/14) and for TBB 14% (2/14).ConclusionsEven in lesions ≤ 3 cm application of TBCA results in an only marginally lower success rate compared to lesions > 3 cm. Due to the overall high success rate we suggest to apply the easy-to-handle and inexpensive method of TBCA in diagnostic procedure of peripheral lung carcinoma.

Exclusive Diagnostic Contribution of the Histology Specimens Obtained by 19-Gauge Transbronchial Aspiration Needle in Suspected Malignant Intrathoracic Lymphadenopathy

Transbronchial needle aspiration (TBNA) performed with a 19-gauge needle provides both cytologic and histologic specimens. However, the diagnostic yield for malignancy gained by histologic examination is unclear. Moreover, this kind of needle is often reserved only for selected cases, in part due to fear for complications. The primary aim of this study was to investigate the diagnostic contribution for malignancy added by histologic to the cytologic specimen examination. The secondary aim was to evaluate the safety of using a 19-gauge needle routinely in all patients. Consecutive patients presenting with mediastinal and/or hilar lymph node enlargement of > or = 1 cm, in whom suspicion for malignancy was raised, underwent TBNA with a 19-gauge needle. Patients with negative aspirate test results underwent surgical investigation. Among 77 patients who were examined, 66 had malignant intrathoracic lymphadenopathy. TBNA proved malignancy in 58 patients, whereas it missed the diagnosis in 8 patients (sensitivity, 87.9%; negative predictive value, 57.9%). TBNA established the diagnosis in 94% of patients with small cell lung cancer (SCLC), and in 88% of patients with non-SCLC (p = 0.7). Exclusive diagnosis was obtained in 36.4% of patients by histology (compared with 18.2% of patients by cytology [p = 0.06]), representing an increase of 35.3% in the diagnostic yield of TBNA over sole cytology examination. No major complication occurred. Histology specimens obtained exclusively with a 19-gauge TBNA needle enabled diagnosis in about 36% of patients with malignant intrathoracic lymphadenopathy. The routine use of a 19-gauge needle is safe.

E08-02: EBUS-TBNA: Real-time endobronchial ultrasound guided transbronchial needle aspiration

E08-02: EBUS-TBNA: Real-time endobronchial ultrasound guided transbronchial needle aspiration

Transbronchial decompression of emphysematous bullae: a new therapeutic approach

Bullae are common accompaniments of chronic obstructive pulmonary disease especially emphysema. They contribute to increased lung volume and worsen the mechanical disadvantage of the inspiratory muscles by increasing the residual volume (RV) and RV/total lung capacity ratio. Thus effective decompression of a large bulla or bullae is thus important to improve the lung function of affected patients and also to provide symptomatic relief. Surgery and thoracoscopy are two commonly performed procedures used to treat bullae. Although bronchoscopic lung volume reduction has been successfully accomplished for emphysema, isolated decompression of bullae bronchoscopically has not been tried to date. A large emphysematous bulla in the left lower lobe of a surgically unfit patient was bronchoscopically punctured with a transbronchial aspiration needle; the position of the needle inside the bulla was confirmed and the air from the bulla was aspirated slowly to allow collapse. Finally, some autologous blood was instilled into the bulla before the needle was withdrawn. The patient had immediate and sustained symptomatic relief with significant improvement in lung function. Bronchoscopic transbronchial decompression of emphysematous bullae can be an effective therapeutic option and warrants further investigation.

Diagnostic Yield of eXcelon, a New Transbronchial Histology Aspiration Needle in Patients With Mediastinal Lymph Node Enlargement

Background Transbronchial needle aspiration (TBNA) is a safe and minimally invasive technique in the assessment of patients with enlarged mediastinal lymph nodes. In this study, the diagnostic yield of a new transbronchial aspiration needle is examined. Methods At a nonuniversity teaching hospital, all consecutive patients with enlarged mediastinal N2 and N3 lymph nodes, accessible on computed chest tomography for TBNA, were selected prospectively. TBNA was performed with a 19-gauge eXcelon transbronchial aspiration needle (Boston Scientific Corporation Natick, MA) by 5 different bronchoscopists. Cytology and histology specimens were obtained with the same needle. TBNA results were considered to be diagnostic if cytologic or histologic examination revealed a malignant lesion or nonmalignant lymphoid cells. Otherwise, TBNA outcome was considered nondiagnostic, that is, no representative cells were obtained. Results In a total of 150 patients eligible for TBNA, 176 nodes were sampled. In 74% (130/176), TBNA was diagnostic in cytology and/or histology specimens. Malignancy was demonstrated in 69% (122/176). In 67/176 patients (38%), a diagnostic histologic core of tissue was obtained. Cytology was diagnostic in 122/176 (69%). No complications were observed. Conclusions TBNA with the eXcelon transbronchial aspiration needle has a high diagnostic yield. Although originally developed for cytology specimen, adequate tissue for histologic examination is obtained in close to 40% of patients with high diagnostic yield. It is easy to use, mainly because of its simple design (without inner needle), and very sharp bevel.

Carcinoid Tumour of the long: T.U. Teaching Hospital experience

Introduction: Bronchial carcinoid tumours are rare tumours which account for 1-2% of lung cancers and arise from cells of the APUD system. Patients and Method: Out of the 1550 cases of lung cancer cases that visited our unit over the last 9½ years, 105 patients underwent lung resections and only 12 cases among them were of bronchial carcinoid tumour. One patient of bronchial carcinoid was treated endobronchially. Results: In this paper we have analyzed a series of 13 patients retrospectively, extracting data from the hospital records of the patients. There were 7 female and 6 male patients and the mean age was 32 years. None had features of carcinoid syndrome but 1 patient had features of Cushing Syndrome. Recurrent chest infection (53.8%) was the commonest presenting symptom and the duration of symptom was from 4 months to 8 years. Transbronchial aspiration cytology, bronchial biopsy and CT guided FNAC were used to establish the diagnosis preoperatively. Pneumonectomy was done in 7 cases, lobectomy in 4 patients and 1 patient underwent bilobectomy. There were no lymph node metastases in all the cases. Histopathologically, 10 cases were typical carcinoid and 3 cases were atypical carcinoid. Other surgical modalities include bronchotomy with wedge resection and sleeve resection which may be done in some selected cases.The patients were followed up from three months to nine and half years. Conclusion: In conclusion, physicians should consider bronchoscopy to evaluate recurrent pneumonia to rule out endobronchial lesions like carcinoid tumour. Bronchial carcinoid tumours are potentially curable tumour when surgical resection is performed. There was no evidence of recurrence in all the 13 cases. However, long term follow up has to be done. Journal of Institute of Medicine Vol.28(1) 2006

Verbreitung zytologischer Verfahren in der bronchoskopischen Diagnostik peripherer pulmonaler Herde

The combination of forceps biopsy and cytological methods improves the yield in diagnostic bronchoscopy of peripheral lung cancer. Transbronchial catheter aspiration seems to be an underutilized cytological technique, which is valuable and minimally invasive. We inquired for the frequency of cytological procedures and the importance of transbronchial catheter aspiration in comparison to transbronchial needle aspiration and bronchial brushing. We sent questionnaires to 99 clinically practising and educating pulmonologists. The response amounted to 69 %. Nearly 79 % of the pulmonologists usually combine forceps biopsy with cytological procedures. Instead of 51 % bronchial brushing, transbonchial catheter aspiration as well as needle aspiration is the most applied cytological technique by only 28 % of the interrogated physicians. 47 % of the investigators practise bronchial washing and 27 % practise core roll preparations as a rule. Most of the specialized clinics in respiratory medicine in Germany add cytological methods to transbronchial forceps biopsy. This practice is pregnant with meaning because of a higher diagnostic yield while accuracy is likewise high. Unlike bronchial brushing transbronchial catheter aspiration and needle aspiration are underutilized for different reasons in spite of the fact, that these are the only procedures with a significant higher sensitivity in comparison to forceps biopsy.

Transbronchial needle aspiration cytology of subcarinal lymph nodes for the staging procedure in the diagnosis of lung cancer

The aim of this study was to improve the staging of lung cancer with or without lymphadenopathy on chest CT by using transbronchial aspiration cytology (TBAC). TBAC of the subcarinal lymph nodes was performed on 153 consecutive patients with lung cancer, with or without subcarinal lymphadenopathy on chest CT. Thirty-four patients had enlargement of the subcarinal lymph nodes (>1 cm). Eighteen of these had TBAC confirmation of metastases. Another seven patients with no mediastinal involvement on CT were positive for metastases on TBAC. TBAC was the only way to confirm lung cancer in two patients. Therefore, routinely performed subcarinal TBAC contributed to an improved non-operative staging of the patients and diagnosis in 16% (25/153) of the patients with lung cancer. Forty-nine patients with NSCLC had surgical resection of the tumour. Surgical procedure revealed metastases to the subcarinal lymph nodes in three patients in whom the preoperative TBAC diagnosis was normal. No significant complications due to TBAC occurred in any of the patients. TBAC of the subcarinal lymph nodes is a minimally invasive technique for staging of lung cancer and can provide useful information for the diagnosis of metastases to the subcarinal lymph nodes.

Bronchoskopische Diagnostik des peripheren Lungenherdes

Flexible fibreoptic bronchoscopy is frequently performed in patients with endoscopically not visible lesions, especially for establishing a diagnosis in patients with peripheral lung cancer. The usual method for obtaining material for histological analysis is transbronchial forceps biopsy. To gain material for cytological examination transbronchial needle aspiration, transbronchial catheter aspiration or bronchial brushing and bronchial washing can be used. The size of the lesion and its location influence the diagnostic accuracy of bronchoscopy. The reliability of cytological procedures has found general acceptance: the endoscopic investigation can be guided by the results of on-site cytology. The combination of transbronchial forceps biopsy and cytological methods increases the diagnostic yield. In a direct comparison, cytological examination of material from transbronchial needle aspiration and transbronchial catheter aspiration has been found to have a significantly higher diagnostic sensitivity than transbronchial forceps biopsy in peripheral bronchial carcinoma. While transbronchial needle aspiration makes it possible to obtain tissue from extrabronchial region, catheter aspiration provides material of a larger area of the bronchial mucosa. There is thus no need for an exact positioning of the catheter tip inside the lesion under fluoroscopic guidance.

FIDUCIAL PLACEMENT FOR CYBERKNIFE® STEREOTACTIC RADIOSURGERY USING FLEXIBLE BRONCHOSCOPY AND A MODIFIED TRANSBRONCHIAL ASPIRATION NEEDLE TECHNIQUE

PURPOSE: CyberKnife Frameless Image-Guided Radiosurgery with the SynchronyTM Motion Tracking Module is now available for the treatment of thoracic malignancies. Gold fiducial markers are required for the treatment planning and tracking of the tumor during each treatment. Fiducials have traditionally been placed under CT-guidance. We describe our center's experience placing fiducials using flexible bronchoscopy with a transbronchial aspiration needle (TBNA).

CHAPTER 21: Diagnosis, treatment, and prevention of aspiration pneumonia (excluding large‐volume aspiration)

Aspiration pneumonia develops as a result of the microaspiration of oral contents due to swallowing dysfunction. Even healthy adults may develop aspiration while sleeping; however, bacteria are usually eliminated by mucociliary transport by the next morning. However, the amount of aspiration increases due to decreased cough reflex or severely impaired mucociliary transport in elderly people or persons with underlying diseases, which associated with humorally or cellularly immune compromised state, leads to the condition of becoming easily infected with aspiration pneumonia. Particularly, patients with cerebral infarction centring on basal ganglion disorder easily develop aspiration pneumonia. There are approximately 108/mL of resident bacteria in the sputum of healthy individuals, which is known to increase to 1011/mL under unsanitary conditions in the mouth or in the presence of periodontal disease. Most oral bacteria are anaerobic, and aerobic bacteria account for only one-tenth to one-hundredth of anaerobic bacteria. Therefore, it is difficult to detect the etiologic agent of aspiration pneumonia by the usual sputum culture test, and further testing is necessary to consider possible bacterial contamination in the mouth. Transbronchial aspiration or percutaneous lung needle aspiration are superior tests to identify the etiologic agent, and it is of value to perform such tests in severe cases or on patients who failed to respond to empiric treatment. Of bacteria causing aspiration pneumonia, anaerobic bacteria such as Peptostreptococcus spp., Prevotella spp., and Fusobacterium spp. are frequently detected. S. milleri spp. that are included in aerobic bacteria in a broad sense may be involved in the development of aspiration pneumonia; however, Bacteroides fragilis is less likely to cause aspiration pneumonia. The most frequently detected anaerobic bacterium is Staphylococcus aureus, followed by Klebsiella, Enterobacter, Streptococcus pneumoniae, and Pseudomonas aeruginosa. The frequency of isolating fungi, Nocardia spp., Actinomyces spp., and Paragonimus spp. is extremely low. Existence of underlying diseases listed in Table 21.1, and the presence of drugs usually used (antipsychotic drugs, anticholinergic agents, and muscle relaxants, etc.) Clinical findings associated with suspected dysphagia Choking while eating, cough, constant croaking sound in the throat, saliva flowing due to the inability to swallow, taking much time to eat, large amounts of dirty sputum, change in the voice quality, etc. Simple tests: Water drinking test, repeated spectrum swallowing test, and simple swallowing provocation test Thorough tests: Plain X-ray, radiography for swallowing, nasal and pharyngolaryngeal fibrescopy, and scintigraphy Antimicrobial agents effective against anaerobic bacteria should be used. Penicillins with a β-lactamase inhibitor, clindamycin, and carbapenem antimicrobial agents, etc. are recommended. Promotion of awareness of eating and drinking, and maintenance of the posture to prevent aspiration Oral care Improvement in aspiration with ACE inhibitors Gastrostomy or tracheo-oesophageal transection (Strict examination necessary to decide if such a procedure is appropriate for the relevant patient.)

Detection of epidermal growth factor receptor mutation in transbronchial aspiration cytology of non-small cell lung cancer

7175 Background: Somatic mutations of epidermal growth factor receptor (EGFR) strongly associate with objective response to EGFR tyrosine kinase inhibitors. There are some problems to practically use it as prognostic markers. Since it is difficult to obtain sufficient tumor samples from non-small cell lung cancer (NSCLC) patients, they are often diagnosed by cytological procedure alone. Therefore, it is very useful if EGFR mutations are able to be detected in cytological samples. The aims of this study are to detect EGFR mutations in the samples of transbronchial aspiration cytology (TBAC) by using direct sequencing and Scorpion ARMS method, and to compare the sensitivities of these methods. Patients and Methods: 94 patients diagnosed as NSCLC in our institute were enrolled in this study, consisting of 63 males and 31 females with a median age of 66. In cytologic diagnosis, they were adenocarcinoma in 58, squamous carcinoma in 24, and the others in 12. DNA was extracted from the TBAC samples, and EGFR mutations were analyzed using direct sequencing (exon 19 and exon 21) and Scorpion ARMS method (E746-A750del and L858R). Results: The mutations were detected in 31patients (33%). 13 mutations (14%) (E746-A750del; 6 patients, L858R; 7 patients) were detected by direct sequencing. 27 mutations (29%) (E746-A750del; 16 patients, L858R; 11 patients) were detected by Scorpion ARMS method. Conclusion: EGFR mutations were able to be detected in TBAC samples by both methods. Scorpion ARMS method is more sensitive for the detection of EGFR mutations than direct sequencing. No significant financial relationships to disclose.

Transbronchial Fine Needle Aspiration Cytological Examination: A Useful Tool for Diagnosing Primary Lung Cancer

Obtaining a definitive preoperative diagnosis plays a critical role in deciding upon the treatment approach for lung carcinoma. However, success in making definitive diagnoses of small primary lung cancers will require new approaches because these cancers are difficult to detect using standard biopsy procedures. We evaluated the results of morphologic definitive diagnosis together with various clinical factors in 1003 primary lung cancers resected surgically. Patients underwent transbronchial brushing, fine needle aspiration cytology, forceps biopsy, and/or forceps biopsy-stamp cytology for preoperative diagnoses, in conjunction with the use of Diff-Quik to confirm that hits had been made on the radiographic shadows before terminating the examinations. Sensitivities of the diagnostic procedures for primary lung cancers were as follows: 64.8% for brushing, 56.1% for transbronchial forceps biopsy, 72.0% for transbronchial forceps biopsy-stamp cytology, and 86.4% for transbronchial fine needle aspiration. The four transbronchial biopsy procedures had a combined overall sensitivity of 92.7%. In patients with peripheral lung cancers of 2 cm or less in diameter, transbronchial fine needle aspiration had a sensitivity of 75.9%, which was the highest sensitivity for all transbronchial examinations. In the subset of 296 patients who underwent all four transbronchial biopsy examinations, transbronchial fine needle aspiration had the highest sensitivity of preoperative diagnosis of all the transbronchial examination methods. The sensitivity of preoperative cytological diagnosis for primary lung cancers, especially transbronchial aspiration cytology, is high. Transbronchial fine needle aspiration cytology is useful for the preoperative diagnosis of primary lung cancer.

Utility of Rapid On-Site Evaluation of Transbronchial Needle Aspirates

Background: Rapid on-site evaluation has been proposed as a method to improve the yield of transbronchial needle aspiration. Objectives: This study investigated whether on-site analysis facilitates routine diagnostic bronchoscopy in terms of sampling, yield and cost. Methods: Patients with lesions accessible for transbronchial needle aspiration on computed tomography were investigated. A cytopathologist screened the needle aspirates on site for the presence of diagnostic material. The bronchoscopic sampling process was adjusted according to the results. In 90 consecutive patients with neoplastic disease (n = 70; 78%), non-neoplastic disease (n = 16; 18%) or undiagnosed lesions (n = 4; 4%) we aspirated 162 lung lesions (paratracheal tumours or lymph nodes: 7%; tracheobronchial lymph nodes: 68%; other: 25%). Results: The diagnostic yield of needle aspiration was 77 and 25% in patients with neoplastic and non-neoplastic lesions, respectively. Sampling could be terminated in 64% of patients after needle aspiration had been performed as the only diagnostic modality, and on-site analysis identified diagnostic material from the first site aspirated in 50% of patients. Only in 2 patients (2%) diagnostic aspirates were not recognized on site. On-site analysis was cost effective due to savings for disposable diagnostic tools, which exceeded the extra expense for the on-site cytology service provided. Conclusions: Rapid on-site analysis of transbronchial aspirates is a highly useful, accurate and cost-effective addition to routine diagnostic bronchoscopy.

Multitarget FISH Analysis in the Diagnosis of Lung Cancer

The aim of the present study was to explore the diagnostic usefulness of the multitarget fluorescence in situ hybridization (FISH) test, LAVysion (Vysis, Downers Grove, IL), for the detection of lung cancer cells in cytologic specimens. Specimens from bronchial washings, bronchial brushings, and transbronchial fine-needle aspirates (TBNAs) from 100 patients with suspected lung cancer and from a control group of 71 patients with nonneoplastic lung disorders were analyzed. FISH positivity was defined as more than 5 cells with gains of at least 2 chromosomes or gene loci. FISH significantly improved the sensitivity of bronchial brushings from 49% to 73%. The specificities of FISH and cytologic examination were 87% and 100%, respectively. In contrast, FISH provided no additional diagnostic information in TBNAs and bronchial washings. There was no increased prevalence of genetic changes in contralateral bronchial washings from patients with lung cancer compared with the control group. The quantity of previous smoking had no effect on the prevalence of chromosomal changes.