The EBUS-TBNA Follow-Up of Cases with Cytological Diagnoses of Atypical/Suspicious Cells in Lung Cancer Patients. A Retrospective Study among 661 Cases.
Delicia Munfus-McCray, Rex Chin Wei Yung, David Feller-Kopman, Douglas Clark, Qing Kay Li. Johns Hopkins Hospital, Baltimore, MD
Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been increasingly used by clinicians in the US. Our published data and others have shown that EBUS-TBNA has higher sensitivity and specificity than conventional TBNA in staging of lung cancers. Our data also showed that EBUS-TBNA has a significantly lower non-diagnostic rate (8.7%) compared to TBNA (28.3%, P<0.05) in staging lung cancers. However, 5 to 10% of EBUS-TBNA specimen has been diagnosed as atypical cells and/or suspicious for malignancies. In this study, we have investigated the follow-up EBUS-TBNA cytological diagnostic yield and histological correlation of these cases in clinically suspicious lung cancer patients.
Design: A computer search of the cytopathology archives at a major teaching hospital revealed 661 EBUS-TBNA cases over a 50 month time period. Among them, 340 cases (51%) and 208 cases (31%) were diagnosed as malignant and benign lesions, 82 cases (12%) were diagnosed as atypical and/or suspicious for malignancy. 47 cases had follow-up repeat EBUS-TBNA. All cytological material was correlated with corresponding follow-up cytological/surgical material.
Results: Of 47 repeat EBUS-TBNA (23 LN cases and 24 lung cases), the most frequently sampled locations were station 4R, 7, right upper lobe and right lower lobe. Malignancy was diagnosed in 24 of 47 cases (51.1%). The most frequent malignant diagnosis was lymphoma (29%), followed by adenocarcinoma (21%), squamous cell carcinoma (21%) and non-small cell carcinoma (17%). 23 of 47 cases (48.9%) were diagnosed as benign; 16/23 cases were later found to have cancer diagnosed by surgical follow-up or clinical progression. Among repeat EBUS-TBNA, the sensitivity and specificity were 91.7% and 60.0% in lymph node sampling; and were 91.7% and 16.7% in lung sampling. In addition, repeat EBUS-TBNA was able to provide sufficient tumor tissue for EGFR and KRAS studies in 5 of 5 adenocarcinoma cases.
Conclusions: Our data showed that repeat EBUS-TBNA was able to further confirm the clinical suspicion of malignancy, particularly in locally advanced and/or metastatic lung cancer patients. It was also able to provide tumor tissue for molecular study. In addition to sampling error, the sensitivity and specificity of repeat EBUS-TBNA may also relate to the complexity, size, and location of lesions.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 228, Monday Morning