[467] Cytology of EBUS-TBNA Versus Conventional TBNA in Diagnosing and Staging of Lung Cancers. A Retrospective Study with Histologic Correlation

LM Stoll, R Yung, D Clark, QK Li. Johns Hopkins Hospital, Baltimore, MD

Background: Conventional endoscopic transbronchial needle aspiration (TBNA) is a common procedure to obtain samples for diagnosing and staging lung lesions. Recently, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been developed, with increased use by clinicians. Clinical data suggests that EBUS-TBNA has higher sensitivity and specificity than blind conventional TBNA in staging lung cancers. The purpose of our study is to investigate cytological features and the cytological diagnostic accuracy of these procedures.
Design: A computer search of our hospital for transbronchial fine needle aspirations (FNA) revealed 188 EBUS-TBNA cases (308 lymph nodes; 47 lung lesions) and 74 TBNA cases (106 lymph nodes; 44 lung lesions) over14 month time period. Sixty-eight percent of the cases had corresponding surgical material to correlate.
Results: Patients' ages ranged from 17 to 89 years old. Male and Female ratio was 1:0.8.

Table 1. Summary of cytologic diagnoses in lymph nodes and lung lesions.
Diagnoses Lymph node FNA Lung FNA
TBNAEBUS-TBNATBNAEBUS-TBNA
Benign/Reactive 40 (37.7%) 149 (48.4%) 8 (18.2%) 14 (29.8%)
Granuloma 16 (15.1%) 35 (11.4%) 3 (6.8%) 2 (4.3%)
Malignancy 18 (17.0%) 84 (27.3%) 26 (59.1%) 27 (57.4%)
Lung Primary 18 71 22 22
AdenoCA618105
SCC41277
SCLC81425
PD CA01832
Carcinoid0102
Lymphoma0801
Metastases01345
Atypical cells 0 2 (0.6%) 4 (9.1%) 3 (6.4%)
Suspicious for CA 2 (1.9%) 11 (3.6%) 2 (4.5%) 0
Non-diagnostic 30 (28.3%) 27 (8.7%) 1 (2.3%) 1 (2.1%)
Total 106 (100%) 308 (100%) 44 (100%) 47 (100%)
SCC=squamous carcinoma; SCLC=small cell lung carcinoma; PD CA=poorly differentiated carcinoma; CA=carcinoma

Cytology-histology correlation revealed that both TBNA and EBUS-TBNA had similar diagnostic profiles for lung lesions. However, for evaluation of malignant lymph nodes, 4 out of 65 (6.2%) was missed by EBUS, and 9 out of 40 (22.5%) was missed by TBNA.
Conclusions: Our data showed that EBUS-TBNA had a higher accurate diagnostic rate than conventional TBNA for staging of lymph nodes. Our findings suggest that EBUS-FNA cytology is an optimal modality for diagnosing and staging in clinically suspected lung cancer patients.
Category: Cytopathology

Monday, March 22, 2010 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 56, Monday Morning

 

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