Contribution of Bronchial Brushings to Diagnostic Yield of Superdimension® Navigational Bronchoscopy Procedures.
Kristin A Pierce, Susan Maygarden. UNC Chapel Hill, NC
Background: Electromagnetic navigation bronchoscopy (ENB) allows access to peripheral lung lesions that are beyond the reach of conventional bronchoscopes in a minimally invasive manner. Preliminary cytologic evaluation during these procedures is attempted to provide guidance for immediate management. After the navigational bronchoscope is introduced, brushes, aspiration needles, and forceps are introduced for specimen collection.
Design: Retrospective analysis of 32 cytopathology cases from 2007 to 2010 in which bronchial brushings (BB) were obtained using the superDimension® Electromagnetic Navigation Bronchoscopy system was performed to determine if evaluation of the BB contributed to the diagnostic yield of the case. Number of BB passes, concomitant endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) and biopsy results, and clinical and pathologic followup were recorded. Slides were prepared by smearing the brush on a glass slide and staining with Diff-Quik stain and immediately examined without a coverslip. Rapid assessment of the BB and EBUS-FNA specimens was performed by cytopathology attending staff and fellows.
Results: Preliminary assessment was provided in 31 of 32 BB cases examined. Mean number of BB slides/case was 3.1. 25 cases had concomitant EBUS-FNA, and 22 cases had concomitant transbronchial biopsy (TBB). Of the 31 BB preliminaries, 5 had definitive diagnoses (4 for malignancy, 1 for fungus), 18 were negative, and 8 were atypical or suspicious for carcinoma. The five definitive cases were confirmed by biopsy, EBUS or clinical impression. Four atypical cases were diagnosed as cancer at final sign out or on a subsequent specimen, 1 was shown to be fungus, and the remaining 3 were negative. Followup of the 18 negative cases showed that 12 had tissue followup (8 TBB, 3 percutaneous core biopsy, 2 wedge biopsy, 1 subcarinal FNA). All of the followup TBB were negative. The 5 patients with wedges or cores were shown to have malignancies. 5 patients with negative BB with or without negative TBB were clinically felt to have malignancies and presumptively given radiation therapy.
Conclusions: Preliminary assessment of bronchial brushings from ENB procedures yielded definitive diagnoses in only 16% of cases (95% CI .03-.291) at the time of the procedure. Rapid assessment of BB specimens can be challenging and time consuming. Reactive bronchial cells may appear quite atypical when stained with Diff-Quik and examined without a coverslip. Definitive diagnosis at the time of the procedure should be reserved for straightforward cases, as this will usually abort the procedure.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 76, Tuesday Morning