From cytology to histology: diagnosis of a relapsed mediastinal lymphoma by endobronchial ultrasound transbronchial histological needle

Endobronchial ultrasound guided Echo Tip Ultra HD 22G needle versus Echo Tip Pro Core HD 22G needle in diagnosis of mediastinal lesions

Background

Convex probe endobronchial ultrasound is a minimally invasive technique used for performing real-time transbronchial needle aspiration of enlarged hilar and mediastinal lymph nodes and could be used for diagnosing proximal peribronchial lesions. Although computed tomography, magnetic resonant imaging, and positron emission tomography/computed tomography have relatively high sensitivity for mediastinal evaluation, pathology is the gold standard. This study compared between Echo Tip Ultra HD-EBUS 22G needle and Echo Tip ProCore HD-EBUS 22G needle in diagnosis of mediastinal lesions using convex probe endobronchial ultrasound.

Results

Twenty-four patients with mediastinal lesions were included. Convex probe endobronchial ultrasound-guided transbronchial needle aspiration using both Echo Tip Ultra HD 22G and Echo Tip ProCore HD 22G needles was done to all patients with no peripheral lymph node enlargement. CP-EBUS TBNA had diagnostic accuracy 50%, sensitivity 47.6%, and specificity 100% in diagnosis of mediastinal lesions. The Echo Tip Ultra HD needle had diagnostic accuracy 40.9%, sensitivity 38%, and specificity 100% compared to the Echo Tip ProCore HD needle which had diagnostic accuracy 31.8%, sensitivity 82.5%, and specificity 100%. The difference between both needles was statistically insignificant. The Echo Tip Ultra 22G HD needle had more representative cellularity (82%) compared to the Echo Tip ProCore 22G HD needle (45%) with a significant difference between both needles (p value = 0.001).

Conclusion

Both needles can be used equally in sampling mediastinal lesions. This study supports that Echo Tip Ultra HD and Echo Tip ProCore HD needles can be used equally in sampling of mediastinal lesions and supports ultrasound screening of enlarged supraclavicular and cervical lymph nodes before performing EBUS-TBNA in patients with mediastinal lesions.

The value of cell block based on fine needle aspiration for lung cancer diagnosis

BACKGROUND

Computed tomography (CT)-guided percutaneous lung fine needle aspiration (FNA) is a convenient method to obtain samples from pulmonary lesions. FNA has a lower rate of complications than the use of a core needle biopsy, but is more difficult for the diagnosis of cytological samples. We use cell block (CB) and immunocytochemistry (ICC) to improve the accuracy of cytological diagnoses based on CT-guided percutaneous lung FNA.

METHODS

We collected 526 cytological samples obtained using CT-guided percutaneous lung FNA at Shanghai Pulmonary Hospital from May 2015 to October 2015. CBs were created from these samples, and ICC was performed to help the further histological classification and confirmation of tumor as primary or metastatic. An automated Ventana ALK with clone D5F3 was used to identify ALK fusion protein.

RESULTS

After assessment of the CBs, 32 (6.08%) diagnoses of suspected malignancy were reduced to 10 (1.90%) such diagnoses (P<0.05), and 161 (30.61%) cases of non-small-cell lung carcinoma (NSCLC) were reduced to 33 (6.27%) cases (P<0.05) after their division into specific subtypes. We also diagnosed eight (1.52%, P<0.05) cases of metastatic carcinoma of the lung that were difficult to diagnose by cytological smear alone. Six (3.73%) of 161 NSCLC cases exhibited ALK rearrangement.

CONCLUSIONS

CB and ICC are useful for accurate cytological diagnosis using CT-guided percutaneous lung FNA. These approaches are valuable for providing individualized treatment and prognostic evaluations with minor complications.