Transbronchial Aspiration Cytology Research Articles

原発性肺癌における経気管支針吸引細胞診 (Transbronchial Aspiration Cytology : TBAC) による縦隔リンパ節及び肺門リンパ節転移の術前質的診断の検討

原発性肺癌における経気管支針吸引細胞診 (Transbronchial Aspiration Cytology : TBAC) による縦隔リンパ節及び肺門リンパ節転移の術前質的診断の検討

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

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.

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.

A Case of T0 Small Cell Lung Cancer

Background. Lung cancer rarely shows a lymph node metastasis to pulmonary hilar and/or mediastinal regions without the primary site of the lung being unable to be detected. Case. A 68-year-old man demonstrated a right abnormal hilar shadow on a chest X-ray film. A computed tomography (CT) revealed an enlarged mass at the right pulmonary hilar node, and this mass was diagnosed to be poorly differentiated carcinoma by transbronchial aspiration cytology. However, no primary lesion in the lung was apparent, and the extrathoracic findings showed no abnormalities despite a thorough examination. We thus performed a tumorectomy with right upper lobectomy and mediastinal nodal dissection because of the possibility of a lung origin based on the lymphatic routes to the tumor. The microscopical and immunohistochemical findings were consistent with small cell carcinoma in the pulmonary hilar node. Although no primary lesion of the resected lobe and also other lobes of the lung was found despite detailed examinations, positive immunoreactivity against anti-thyroid transcription factor-1 (TTF-1) antibody revealed this tumor to have originated in the lung. Therefore, we consider that this patient is a rare case of primary unknown T0 lung cancer with metastasis in the pulmonary hilar lymph node. Conclusions. In case of T0 lung cancer, since the primary lesion may later be identified, a strict follow-up study after the operation is necessary.

Transbronchial needle aspiration for lung cancer patients, especially for the cases in which cancer cells were negative in the specimens taken by the brushing method

Cancer cells were negative in the specimens taken from 4 cases by the transbronchial peripheral brushing method through bronchoscope. These lesions had originated in the unsuitable sites for taking the specimens for diagnosis. It was suggested that the transbronchial aspiration cytology with a needle improved by us is suitable for the establishment of diagnosis of such lesions.