Endobronchial Ultrasound-Guided Fine-Needle Aspiration Cytology, a More Efficacious Diagnostic Modality to EBUS-Core Needle Biopsy – The Washington University Experience
Cletus Baidoo, Jeff F Wang, Ranjit Sarkar. Washington University in St Louis, St. Louis, MO; Barnes-Jewish Hospital, St. Louis, MO
Background: Although, mediastinoscopy and CT-guided biopsy remain the gold standard procedure for assessing mediastinal lymph nodes and pulmonary lesions, Endobronchial Ultrasound-Guided Fine-Needle Aspiration (EBUS-FNA) has emerged as a quintessential less invasive tool for accessing and cytologic evaluation of mediastinal lymph nodes and pulmonary masses for the purpose of cancer staging and primary diagnosis, respectively. At the Washington University School of Medicine, immediate cytologic assessment and diagnosis of EBUS-FNA is done by telepathology. We compare the diagnostic yield of EBUS-FNA cytology to EUBS-core needle biopsy (CNB).
Design: We performed a retrospective cohort study by reviewing and comparing the electronic medical record database of EBUS-FNA and EBUS-CNB, (histologic) diagnoses of all patients at our institution who underwent EBUS-FNA procedure between December 12, 2010 to August 10, 2012. A total of 476 patients were used in this study. Of these, 224 patients had concurrent core biopsies.
Results: Of the 476 cases examined, the mean age was 62+/-14 years with 53% being males. In 249 out of the total cases, the less invasive FNA aspiration technique alone produced enough diagnostic cytology material removing any need for concurrent tissue core biopsy. Of the 249 cases, 164 were diagnosed as malignant tumors. As expected, the diagnostic yield of EBUS-FNA cytology was similar to EBUS-CNB (95% compared to 94%, respectively). However, there was discordant diagnosis between cytology and histology in 19 of 227 cases who had both EBUS-FNA and EBUS-CNB done concurrently (∼8.4%). Of the discordant diagnostic cases, 12 were correctly diagnosed as malignant by cytology but negative for malignancy by CNB. Four of the 19 discordant cases were called negative for malignancy by cytology and but proved to be malignant by histology. Another two of the 19 discordant cases were diagnosed as granulomatous inflammation by histology but were not picked up by cytology. The last of the 19 cases was diagnosed as malignant by both methods but as a totally different tumor (metastatic squamous cell versus metastatic urothelial cell carcinoma).
Conclusions: EBUS-FNA cytology is more efficacious, less invasive, and shows high-yield accurate diagnosis for mediastinal lymph node and pulmonary lesions as compared to EBUS-CNB.
Monday, March 4, 2013 1:00 PM
Poster Session II # 68, Monday Afternoon