The Diagnostic Efficacy of Combining Bronchoscopic Tissue Biopsy and Endobronchial Ultrasound-Guided Fine Needle Aspiration for the Diagnosis of Malignant Tumors in the Lung.
Lauren Ende, Dara L Aisner, Zubair Baloch, Daniel Sterman, Anil Vachani, Colin Gillespie, Andrew Haas, Leslie A Litzky. Hospital of the University of Pennsylvania, Philadelphia
Background: Bronchoscopic tissue forceps biopsy (BBX) is a standard procedure for diagnosis of malignancy in the lung. Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) has also proved to be a sensitive alternative to tissue biopsy for the diagnosis and staging of lung tumors. We report our institutional experience of diagnostic yield when combining BBX and EBUS-FNA in the bronchoscopic evaluation of patients who present with lung lesion(s).
Design: The pathology files at our institution were searched for all BBXs performed between 1/09 and 6/10 for the diagnosis of malignancy and to select patients that had undergone combined EBUS-FNA and BBX procedures. The data points included site of the biopsy, cytologic and histopathologic diagnoses and available clinical follow-up.
Results: A total of 288 BBXs were reviewed; 118 patients had BBX combined with EBUS-FNA and 110(93%) patients received a definitive pathologic diagnosis. Malignancy was diagnosed in 96(81%) patients; BBX and EBUS-FNA of the lung lesion only were performed in 22 patients, BBX and EBUS-FNA of the lymph node(s) only in 79 patients with BBX and a combination of EBUS-FNA of the lung lesion and lymph node(s) in 17 patients. Of the 21 patients with malignant diagnoses who underwent BBX and EBUS-FNA of the lung lesion only, 13(62%) had tumor in both, 3(14%) had tumor only in BBX and 5 (24%) had tumor only in EBUS-FNA. Of the 64 patients with malignant diagnoses that underwent BBX and lymph node staging by EBUS-FNA, 29(45%) had tumor in both, 19(30%) had tumor only in BBX and 16(25%) had tumor only in EBUS-FNA(s). Of the 11 patients who underwent BBX and EBUS-FNA of the lung lesion and lymph node(s), 5(45%) had tumor present in all specimens, 2(18%) had tumor in BBX and EBUS- FNA of the lung lesion only, 3(27%) had tumor only in BBX and 1(9%) had tumor in only EBUS-FNA of the lung lesion. Immunostains were performed for 74(77%) patients and molecular testing for 12(13%) patients.
Conclusions: In our experience, diagnostic yield is increased when bronchoscopic diagnostic technologies (BBX and EBUS-FNA) are combined. In a significant number of patients where BBX was negative, EBUS-FNA provided diagnostic material, thus increasing diagnostic yield by 18%. In a subset of these patients the EBUS-FNA also helped in the staging of a primary tumor. By combining these procedures, more tissue was obtained for immunohistochemistry and molecular testing, which facilitated personalized clinical management in a minimally invasive manner.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 227, Monday Morning