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Ramieri MT, Marandino F, Visca P, Salvitti T, Gallo E, Casini B, Giordano FR, Frigieri C, Caterino M, Carlini S, Rinaldi M, Ceribelli A, Pennetti A, Alò PL, Marino M, Pescarmona E, Filippetti M. Usefulness of conventional transbronchial needle aspiration in the diagnosis, staging and molecular characterization of pulmonary neoplasias by thin-prep based cytology: experience of a single oncological institute. J Thorac Dis 2016; 8:2128-37. [PMID: 27621869 PMCID: PMC4999774 DOI: 10.21037/jtd.2016.07.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Conventional transbronchial needle aspiration (c-TBNA) contributed to improve the bronchoscopic examination, allowing to sample lesions located even outside the tracheo-bronchial tree and in the hilo-mediastinal district, both for diagnostic and staging purposes. METHODS We have evaluated the sensitivity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the c-TBNA performed during the 2005-2015 period for suspicious lung neoplasia and/or hilar and mediastinal lymphadenopathy at the Thoracic endoscopy of the Thoracic Surgery Department of the Regina Elena National Cancer Institute, Rome. Data from 273 consecutive patients (205 males and 68 females) were analyzed. RESULTS Among 158 (58%) adequate specimens, 112 (41%) were neoplastic or contained atypical cells, 46 (17%) were negative or not diagnostic. We considered in the analysis first the overall period; then we compared the findings of the first [2005-2011] and second period [2012-2015] and, finally, only those of adequate specimens. During the overall period, sensibility and accuracy values were respectively of 53% and 63%, in the first period they reached 41% and 53% respectively; in the second period sensibility and accuracy reached 60% and 68%. Considering only the adequate specimens, sensibility and accuracy during the overall period were respectively of 80% and 82%; the values obtained for the first period were 68% and 72%. Finally, in the second period, sensibility reached 86% and accuracy 89%. Carcinoma-subtyping was possible in 112 cases, adenocarcinomas being diagnosed in 50 cases; further, in 30 cases molecular predictive data could be obtained. CONCLUSIONS The c-TBNA proved to be an efficient method for the diagnosis/staging of lung neoplasms and for the diagnosis of mediastinal lymphadenopathy. Endoscopist's skill and technical development, associated to thin-prep cytology and to a rapid on site examination (ROSE), were able to provide by c-TBNA a high diagnostic yield and molecular predictive data in advanced lung carcinomas.
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Affiliation(s)
| | | | - Paolo Visca
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Tommaso Salvitti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Claudia Frigieri
- Anaesthesia and Intensive Care Complex Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Mauro Caterino
- Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Sandro Carlini
- Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Rinaldi
- Medical Oncology “B” Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Ceribelli
- Medical Oncology “A” Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Annarita Pennetti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Pier Luigi Alò
- Department of Pathology, “F. Spaziani” Hospital, ASL Frosinone, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Filippetti
- Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy
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Abstract
Conventional transbronchial needle aspiration (C-TBNA) provides an opportunity to diagnose mediastinal lesions and stage bronchogenic carcinoma in a minimally invasive fashion. The procedure is easy to learn and requires zero upfront cost. Any community pulmonologist can acquire and maintain the skills of C-TBNA without undergoing formal interventional pulmonary fellowship training. Besides being used for the diagnosis and staging of lung cancer, C-TBNA can be used in patients suspected to have benign conditions such as sarcoidosis and tuberculosis. It also contributes in improving the diagnostic yield of flexible bronchoscopy while dealing with endobronchial, submucosal, peribronchial, or peripheral lesions. C-TBNA may be the only diagnostic modality that can be performed in patients in whom mediastinoscopy is contraindicated due to a bleeding diathesis. The procedure is safe and has great potential to augment the welfare of patients with pulmonary ailments. The learning curve of the procedure is short and steep. Every community pulmonologist should be able to perform C-TBNA.
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Affiliation(s)
- Elif Küpeli
- Pulmonary Diseases Department, School of Medicine, Başkent University, Bahcelievler 06490, Ankara, Turkey
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