1
|
Gong Y, Chen Y, Li J, Xu G, Luo G. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic lymphadenopathy in patients with nasopharyngeal cancer. Am J Transl Res 2024; 16:1757-1768. [PMID: 38883364 PMCID: PMC11170604 DOI: 10.62347/gdmg9203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/24/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE This study aimed to assess the efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in detecting intrathoracic lymph nodes in patients with nasopharyngeal carcinoma (NPC). METHODS Retrospective data analysis was conducted on individuals who underwent EBUS-TBNA between June 2015 and June 2022. Patients with NPC and enlarged intrathoracic lymph nodes were included. Specimens were categorized as malignant or non-malignant, with final non-malignancy confirmation procedures, or 12 months of clinical follow-up. RESULTS Among 97 patients, 59 (60.8%) had NPC with intrathoracic lymph node metastasis, 3 (3.1%) had primary lung cancer involving nodes, and 25 (25.8%) showed benign characteristics. Ten cases (10.3%) were false-negative on initial EBUS-TBNA but confirmed as metastatic on follow-up. For NPC patients with intrathoracic lymphadenopathy, EBUS-TBNA exhibited 86.1% sensitivity (62/72), 71.4% negative predictive value (25/35), and 89.7% accuracy (87/97). Multivariate analysis identified increased lymph node short axis (OR: 1.200, 95% CI: 1.024-1.407; P = 0.041), metachronous NPC (OR: 11.274, 95% CI: 2.289-55.528; P = 0.003), and synchronous lung lesions (OR: 19.449, 95% CI: 1.875-201.753; P = 0.001) as independent predictors of malignant intrathoracic lymphadenopathy. Longer lymph node short axis (OR: 1.305, 95% CI: 1.044-1.631; P = 0.019) was independently associated with EBUS-TBNA accuracy. CONCLUSION EBUS-TBNA effectively diagnoses intrathoracic lymphadenopathy in NPC patients.
Collapse
Affiliation(s)
- Yu Gong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou 510060, Guangdong, The People's Republic of China
- Department of Endoscopy, Sun Yat-sen University Cancer Center No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong, The People's Republic of China
| | - Yufan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou 510060, Guangdong, The People's Republic of China
- Department of Endoscopy, Sun Yat-sen University Cancer Center No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong, The People's Republic of China
| | - Jianjun Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou 510060, Guangdong, The People's Republic of China
- Department of Endoscopy, Sun Yat-sen University Cancer Center No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong, The People's Republic of China
| | - Guoliang Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou 510060, Guangdong, The People's Republic of China
- Department of Endoscopy, Sun Yat-sen University Cancer Center No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong, The People's Republic of China
| | - Guangyu Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou 510060, Guangdong, The People's Republic of China
- Department of Endoscopy, Sun Yat-sen University Cancer Center No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong, The People's Republic of China
| |
Collapse
|
2
|
Vuorisalo A, Huhtala H, Paavonen T, Kholová I. Insufficient endobronchial ultrasound-guided transbronchial needle aspiration specimens. When and why? The analysis of criteria and reasons behind the insufficient specimens. Diagn Cytopathol 2024; 52:271-287. [PMID: 38348643 DOI: 10.1002/dc.25284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The classification terminology systems for pulmonary cytology specimens have recently emerged. Inadequate samples, classified as "nondiagnostic," raise challenges in determining the threshold of cell numbers and the risk of malignancy (ROM). METHODS The study retrospectively reviewed 248 endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples: 46 insufficient samples, 60 low cellularity samples, and 142 adequate samples. Characteristics as cellularity, number of benign and malignant cells, and background features were assessed. Receiver operating characteristic curve analysis was performed to establish cell sufficiency thresholds for the diagnosis. RESULTS Out of the 248 samples analyzed, 108 were classified as benign, 94 as malignant, and 46 as insufficient. The study found that the cellularity thresholds for diagnosis in cell blocks and cytological samples were ≥50 cells and ≥100 cells, respectively. The thresholds for tumor cell counts were ≥1 - 10 cells for both types of cells, respectively. Considerably, some low cellularity samples were initially classified as insufficient despite meeting the diagnostic thresholds upon revision. The ROM varied across sample categories, with insufficient samples having a ROM of 10.9%, benign samples 15.7%, suspicious samples 92.0%, and malignant samples 100%. CONCLUSION Insufficient EBUS-TBNA samples raise challenges in diagnosis and management. This study identified the root cause of insufficient samples, including factors related to humans, diagnostic methods, sampling, and laboratory processing. By understanding the root causes, diagnostic recommendations can be developed to improve the diagnostic process. The findings emphasize the importance of standardized classification and terminology systems for clear communication among healthcare professionals and institutions, ultimately improving patient care and enabling quality assurance measures.
Collapse
Affiliation(s)
- Antti Vuorisalo
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Timo Paavonen
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| |
Collapse
|
3
|
Tang CL, Zhu Z, Zhong CH, Zhou ZQ, Zhou HQ, Geng RM, Chen XB, Chen Y, Li SY. Clinical application of endobronchial ultrasonography-guided transbronchial needle aspiration biopsy-a single center, large sample, real-world study. BMC Pulm Med 2023; 23:336. [PMID: 37689634 PMCID: PMC10492366 DOI: 10.1186/s12890-023-02568-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Endobronchial ultrasonography-guided transbronchial needle aspiration biopsy (EBUS-TBNA) has been used for more than 10 years in China. Its clinical application and diagnostic value in different diseases with large sample was lack of report. METHODS A retrospective analysis was performed about the application and diagnostic value of EBUS-TBNA in different disease of patients in Respiratory Intervention Center of Guangzhou Institute of Respiratory Health from January 2012 to July 2020. RESULTS A total 5758 patients were included with 182 patients excluded for lack of information. Finally, data of 5576 patients (3798 males and 1778 females) were analyzed. For anesthetize, most patients were undergoing general anesthesia of intravenous with spontaneous breathing (69.4%), followed by general anesthesia of intravenous and inhalation with tracheal intubation and mechanical ventilation (17.9%) and conscious sedation and analgesia (12.8%). Lymph nodes were the main sites of biopsy obtained (76.4%). Tumors accounted for the highest proportion of disease (66.4%), followed by infection diseases (9.9%), sarcoidosis (3.9%), lymphoma (1.1%), and others (18.7%). The sensitivity of EBUS-TBNA for diagnosis of tumor was 89.7%, and 40.8% for infection diseases. There were significant differences in the puncture site and proportions of diseases between male and females (both p < 0.05). Higher diagnostic value was found in male patients (p < 0.05). CONCLUSION EBUS-TBNA has good diagnostic value for different mediastinal and central pulmonary space-occupying lesions diseases, with highest sensitivity for tumors. Higher diagnostic value was found in male patients.
Collapse
Affiliation(s)
- Chun-Li Tang
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zheng Zhu
- Department of Allergy and Clinical Immunology, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, Guangzhou, China
| | - Chang-Hao Zhong
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zi-Qing Zhou
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Hui-Qi Zhou
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Rong-Mei Geng
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Xiao-Bo Chen
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Shi-Yue Li
- Department of Respiratory and Critical Care Medicine, National Center for Respiratory Medicine, State Key Lab of Respiratory Disease, The first affiliated hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China.
| |
Collapse
|
4
|
Zuo CY, Xue KY, Wu XM, Lin LC, Luo BQ, Chen ZD, Lin YL, Tian XQ, Ke MY. Value of needle confocal laser microendoscopy combined with endobronchial ultrasound bronchoscopy in the diagnosis of hilar and mediastinal lymph node lesions. Kaohsiung J Med Sci 2023; 39:936-942. [PMID: 37283416 DOI: 10.1002/kjm2.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/13/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
Endobronchial ultrasound bronchoscopy (EBUS) and needle confocal laser endomicroscopy (nCLE) are techniques for screening benign and malignant lesions of the hilar and mediastinal lymph node (HMLN). This study investigated the diagnostic potential of EBUS, nCLE, and combined EBUS and nCLE in HMLN lesions. We recruited 107 patients with HMLN lesions who were examined by EBUS and nCLE. A pathological examination was performed, and the diagnostic potential of EBUS, nCLE, and combined EBUS-nCLE approach was analyzed according to the results. Among the 107 cases of HMLN lesions, 43 cases were benign and 64 cases were malignant on pathological examination, 41 cases were benign and 66 cases were malignant on EBUS examination; 42 cases were benign and 65 cases were malignant on nCLE examination; 43 cases were benign and 64 cases were malignant on combined EBUS-nCLE examination. The combination approach had 93.8% sensitivity, 90.7% specificity, and 0.922 area under the curve, which was higher than those of EBUS (84.4%, 72.1%, and 0.782, respectively) and nCLE diagnosis (90.6%, 83.7%, and 0.872, respectively). The combination approach had a higher positive predictive value (0.908), negative predictive value (0.881), and positive likelihood ratio (10.09) than that of EBUS (0.813, 0.721, and 3.03, respectively) and nCLE (0.892, 0.857, and 5.56, respectively), whereas, the negative likelihood ratio was lower than that for EBUS (0.22) and nCLE (0.11). No serious complications occurred in patients with HMLN lesions. To summarize, the diagnostic efficacy of nCLE was better than EBUS. The EBUS-nCLE combination is a suitable approach for diagnosing HMLN lesions.
Collapse
Affiliation(s)
- Cui-Yun Zuo
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Ke-Ying Xue
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xue-Mei Wu
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Lian-Cheng Lin
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Bing-Qing Luo
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Zhi-De Chen
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yan-Li Lin
- Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xiao-Qin Tian
- Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Ming-Yao Ke
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| |
Collapse
|
5
|
Aoun-Bacha Z, Bitar N, Saleh WA, Assi H, Bahous J, Boukhalil P, Chami H, Dabar G, El Karak F, Farhat F, Ghanem H, Ghosn M, Juvelikian G, Nasr F, Nehme R, Riachy M, Tabet G, Tfayli A, Waked M, Youssef P. Diagnosis and management of patients with stage III non‑small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review). Oncol Lett 2023; 25:113. [PMID: 36844621 PMCID: PMC9950344 DOI: 10.3892/ol.2023.13699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023] Open
Abstract
Proper management of stage III non-small cell lung cancer (NSCLC) might result in a cure or patient long-term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncologists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care. Whilst chest computerized tomography (CT) scanning remains a cornerstone in the discovery of a lung lesion, a positron-emission tomography (PET)/CT scan and a tumor biopsy allows for staging of the cancer and defining the resectability of the tumor(s). A multidisciplinary discussion meeting is currently widely advised for evaluating patients on a case-by-case basis, and should include at least the treating oncologist, a thoracic surgeon, a radiation oncologist and a pulmonologist, in addition to physicians from other specialties as needed. The standard of care for unresectable stage III NSCLC is concurrent chemotherapy and radiation therapy, followed by consolidation therapy with durvalumab, which should be initiated within 42 days of the last radiation dose; for resectable tumors, neoadjuvant therapy followed by surgical resection is recommended. This joint statement is based on the expertise of the physician panel, available literature and evidence governing the treatment, management and follow-up of patients with stage III NSCLC.
Collapse
Affiliation(s)
- Zeina Aoun-Bacha
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon,Correspondence to: Dr Zeina Aoun-Bacha, Department of Pulmonology and Critical Care, Hôtel Dieu de France Medical Center, Saint-Joseph University, Alfred Naccache Boulevard, Ashrafieh, P.O. Box 2064-6613, Beirut 1104 2020, Lebanon, E-mail:
| | - Nizar Bitar
- Division of Hematology-Oncology, Sahel General Hospital, Beirut 1514, Lebanon
| | - Wajdi Abi Saleh
- Division of Pulmonary Medicine and Critical Care, Clémenceau Medical Center, Beirut 1103, Lebanon
| | - Hazem Assi
- Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Joudy Bahous
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Pierre Boukhalil
- Division of Pulmonary Medicine and Critical Care, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Hasan Chami
- Division of Pulmonary Medicine and Critical Care, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Georges Dabar
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Fadi El Karak
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Fadi Farhat
- Division of Hematology Oncology, Hammoud Hospital University Medical Center, Sidon 1551, Lebanon
| | - Hadi Ghanem
- Division of Hematology-Oncology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1481, Lebanon
| | - Marwan Ghosn
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - George Juvelikian
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Fadi Nasr
- Division of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Ralph Nehme
- Division of Pulmonary Medicine and Critical Care, Lebanese American University Medical Center-Rizk Hospital, Beirut 1481, Lebanon
| | - Moussa Riachy
- Division of Pulmonary Medicine, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1104 2020, Lebanon
| | - Georges Tabet
- Department of Thoracic Surgery, Hôtel-Dieu de France Medical Center, Saint-Joseph University, Beirut 1004 2020, Lebanon
| | - Arafat Tfayli
- Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Mirna Waked
- Division of Pulmonary Medicine, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| | - Pierre Youssef
- Department of Surgery, Saint Georges Hospital University Medical Center, Beirut 1481, Lebanon
| |
Collapse
|
6
|
Shen HS, Lin FC, Tung SM, Chang CY, Chen YM, Chao HS. Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of pulmonary sarcoidosis: A 9-year experience at a single center. J Chin Med Assoc 2023; 86:191-196. [PMID: 36508498 DOI: 10.1097/jcma.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is valuable for diagnosing pulmonary sarcoidosis. We aimed to evaluate the diagnostic yield of EBUS-TBNA and cytology in sarcoidosis during the first 9 years at our institution. METHODS Patients who underwent EBUS-TBNA for suspected sarcoidosis between January 2011 and November 2019 were identified retrospectively. EBUS-TBNA was performed with rapid on-site cytological evaluation of the samples. The final diagnosis was based on the pathology and/or cytology results, radiologic features, and clinical follow-up findings. The yield rate was analyzed annually. RESULTS Eighty patients underwent 83 EBUS-TBNA procedures for suspected sarcoidosis. In total, 136 lymph nodes were sampled. The mean number of lymph node stations sampled was 2.0 ± 0.6; the mean number of needle passes per lymph node was 3.5 ± 0.8. Sixty-five patients were diagnosed with sarcoidosis, with a total of 68 procedures. Nonnecrotizing granulomatous inflammation was detected in the EBUS-TBNA samples from 49/68 procedures (yield rate: 72.1%). Of 19 patients with sarcoidosis who did not obtain a pathological diagnosis with EBUS-TBNA, epithelioid cells and/or multinuclear giant cells suggestive of granulomatous inflammation were detected in five. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for pathological diagnosis of sarcoidosis using EBUS-TBNA were 72.1%, 100%, 100%, and 24.0%, respectively. On using cytology, the sensitivity and NPV increased to 79.4% and 26.3%, respectively. The yield rate did not increase until 2016. CONCLUSION EBUS-TBNA is useful for diagnosing sarcoidosis. Cytology resulted in an additional yield rate of 7.3%, which improved as the number of cases increased.
Collapse
Affiliation(s)
- Hsiang-Shi Shen
- Division of General Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Fang-Chi Lin
- Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Su-Mei Tung
- Division of General Chest Medicine, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Yueh Chang
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
- Division of Chest Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Yuh-Min Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Heng-Sheng Chao
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Chest Medicine, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
7
|
Bonert M, Zafar U, Ramadan S, Finley C, Cutz JC, Foster G, Ask K, Naqvi A. The physician factor and anatomical site in 8846 consecutive mediastinal lymph node aspirations in a cross-sectional study. Sci Rep 2023; 13:1784. [PMID: 36720994 PMCID: PMC9889352 DOI: 10.1038/s41598-022-26962-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/22/2022] [Indexed: 02/02/2023] Open
Abstract
Mediastinal lymph node fine needle aspiration (MLN-FNA) is a common procedure; however, the physician factor in pathological category, and anatomical site are not routinely assessed. Cytology reports for endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS) MLN-FNA specimens (8846) were retrieved for July 2012-Dec 2019, classified by hierarchical free text string match algorithm into 51 diagnostic categories, four mutually exclusive diagnostic groups (benign |suspicious |malignant |insufficient), and 24 anatomical sites. Pathologist and submitting physician/surgeon bias were assessed using logistic regression and funnel plots|control charts centered on the group median (diagnostic/capture) rate. Eleven pathologists and seven submitting physician/surgeon were involved in more than 250 specimens each. Overall, the MLN-FNAs were benign|suspicious|malignant|insufficient in 46%|4%|25%|24% of specimens. Percent malignant (number of samples) varied by station; 7| 4R| 4L| 2R| 10R| 11R| 11L were respectively 21%(3,101), 27%(2,453), 19%(1,289), 41%(435), 27%(497), 24%(357), 26%(229). The number of outlier (P < 0.05/P < 0.001) pathologists of 11 from the group median rate for benign|suspicious|malignant|insufficient was 0/0| 3/1| 0/0| 3/0 respectively. The outlier (P < 0.05/P < 0.001) submitting physicians/surgeons of 7 for benign|suspicious|malignant|insufficient was 3/2| 2/2| 3/2| 3/2 respectively. The physician and anatomical site are significant predictors of MLN-FNA pathology.
Collapse
Affiliation(s)
- Michael Bonert
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Uzma Zafar
- Department of Pathology, Rutgers Health/St. Barnabas Medical Center, Livingston, NJ, USA
| | - Soha Ramadan
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Christian Finley
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, L8S 4L8, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Jean-Claude Cutz
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Gary Foster
- Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Kjetil Ask
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Asghar Naqvi
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. .,Department of Pathology, St. Joseph's Healthcare Hamilton, Room L222-3, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| |
Collapse
|
8
|
Li SJ, Wu Q. Endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic lymphadenopathy with extrathoracic malignancy. World J Clin Cases 2022; 10:13227-13238. [PMID: 36683624 PMCID: PMC9851006 DOI: 10.12998/wjcc.v10.i36.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.
AIM To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies.
METHODS This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy. The specimens were defined as positive for malignancy, negative for non-malignancy (tuberculosis, sarcoidosis, etc.), and without a definitive diagnosis. Sensitivity, negative predictive value (NPV) for malignancy, and overall accuracy were calculated. Complications were recorded.
RESULTS A total of 80 patients underwent EBUS-TBNA and had a final diagnosis, among which 50 (62.5%) were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis, 14 (17.5%) were diagnosed with primary lung cancer with nodal involvement, and 16 (20.0%) exhibited benign behavior including tuberculosis, sarcoidosis and reactive lymphadenitis or who had benign follow-up. The diagnostic sensitivity, NPV, and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8% (n = 60/64), 80.0% (n = 16/20), and 95.0% (n = 76/80), respectively. In the multivariate analysis, longer short axis of the lymph node (OR: 1.200, 95%CI: 1.024-1.407; P = 0.024) and synchronous lung lesion (OR: 19.449, 95%CI: 1.875-201.753; P = 0.013) were independently associated with malignant intrathoracic lymphadenopathy. No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy, and no major complication was observed.
CONCLUSION EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.
Collapse
Affiliation(s)
- Shi-Jie Li
- Endoscopy Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| |
Collapse
|
9
|
Prasad KT, Muthu V, Sehgal IS, Dhooria S, Singh N, Gupta N, Aggarwal AN, Agarwal R. Endosonographic characteristics of mediastinal lymph nodes for predicting malignancy in high tuberculosis burden settings: a study of 774 subjects. Expert Rev Respir Med 2022; 16:1011-1015. [PMID: 36031844 DOI: 10.1080/17476348.2022.2118717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Nalini Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
| |
Collapse
|
10
|
Is endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) reliable and safe procedure in geriatric patients? Aging Clin Exp Res 2022; 34:913-925. [PMID: 34731449 DOI: 10.1007/s40520-021-02012-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Even though studies have indicated the usefulness and safety of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA), elderly patient data are limited due to the small sample sizes. AIM We aimed to evaluate usage and safety of EBUS-TBNA in elderly population. METHODS This single-center retrospective study was conducted with patients who underwent an EBUS-TBNA procedure between September 2011 and December 2019. The patients were categorized into two groups: those aged 65 years or older (elderly group) and those younger than 65 years (younger group). RESULTS 2444 patient data, 1069 of which were in the elderly group, were analyzed. The cytological examination of EBUS-TBNA identified specimen adequacy in 96.8% of patients. One hundred and thirty patients (5.3%) experienced complications, with similar complication rates recorded in both the elderly and younger groups (5.4% vs 5.2%, p: 0.836). Logistic regression analyses revealed that age, and presence of hypertension, diabetes mellitus, coronary artery disease and malignancy are associated significantly with complication-related EBUS-TBNA. For the lymph nodes with a final diagnosis of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EBUS-TBNA revealed a diagnostic performance in excess of 90% except for metastasis and lymphoma. CONCLUSION EBUS-TBNA can be considered a safe and effective technique in patients aged 65 years and over.
Collapse
|
11
|
Zarogoulidis P, Matthaios D, Kosmidis C, Hohenforst-Schmidt W, Tsakiridis K, Mpaka S, Boukovinas I, Drougas D, Theofilatou V, Zaric B, Courcoutsakis N, Nikolaidis G, Huang H, Bai C. Effective early diagnosis for NSCLC: an algorithm. Expert Rev Respir Med 2021; 15:1437-1445. [PMID: 34403620 DOI: 10.1080/17476348.2021.1969916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Lung cancer still remains undiagnosed for most patients until the disease is inoperable. AREAS COVERED We performed search on PubMed with the keywords: EBUS, radial-EBUS, bronchoscopy, lung cancer, electromagnetic navigation, ct-biopsy, transthoracic biopsy. We present diagnostic equipment and imaging techniques such as positron emission tomography, endoscopical navigation systems, endobronchial ultrasound, radial-endobronchial ultrasound, transthoracic ultrasound biopsy, and computed tomography guided biopsies. EXPERT OPINION However, lack of early disease symptoms remains the most important issue and therefore we should direct our efforts to screening and early disease diagnosis. An algorithm is proposed for biopsy upon initial disease diagnosis.
Collapse
Affiliation(s)
- Paul Zarogoulidis
- 3rd Department of Surgery, ``ahepa`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.,Pulmonary Oncology Department, ``Bioclinic`` Private Hospital, Thessaloniki, Greece
| | | | | | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Kosmas Tsakiridis
- Thoracic Oncology Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
| | - Sofia Mpaka
- Oncology Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
| | - Ioannis Boukovinas
- Oncology Department, ``Bioclinic`` Private Hospital, Thessaloniki, Greece
| | - Dimitris Drougas
- Nuclear Medicine Department, ``Bioiatriki`` Private PET-CT Laboratory, Thessaloniki, Greece
| | - Vasiliki Theofilatou
- Nuclear Medicine Department, ``Bioiatriki`` Private PET-CT Laboratory, Thessaloniki, Greece
| | - Bojan Zaric
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Nikolaos Courcoutsakis
- Radiology Department, Democritus University of Thrace, General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George Nikolaidis
- Surgery Department, ``General Clinic`` Euromedica, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| |
Collapse
|
12
|
Tejerina E, Garca Tobar L, Echeveste JI, de Andrea CE, Vigliar E, Lozano MD. PD-L1 in Cytological Samples: A Review and a Practical Approach. Front Med (Lausanne) 2021; 8:668612. [PMID: 34026795 PMCID: PMC8139418 DOI: 10.3389/fmed.2021.668612] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
With a growing number of predictive biomarkers needed to manage patients with non-small cell lung cancer (NSCLC), there has been a paradigm shift in care and handling of diagnostic samples. Among the various testing methods, immunohistochemistry (IHC) is the most cost- effective and widely available. Furthermore, over the past decade immunotherapy has emerged as one of the most promising cancer treatments. In this scenario IHC is the most used testing method available for PDL-1/PD1 immunotherapy. Several monoclonal antibodies targeting programmed death 1 (PD-1)/programmed death ligand-1 (PD-L1) pathways have been integrated into standard-of-care treatments of a wide range of cancer types, once provided evidence of PD-L1 expression in tumor cells by immunohistochemistry (IHC). Since currently available PD-L1 assays have been developed on formalin-fixed paraffin embedded (FFPE) histological specimens, a growing body of research is being dedicated to confirm the feasibility of applying PDL-1 assays also to cytological samples. Albeit promising results have been reported, several important issues still need to be addressed. Among these are the type of cytological samples, pre-analytical issues, cyto-histological correlation, and inter-observer agreement. This review briefly summarizes the knowledge of the role of cytopathology in the analysis of PD-L1 by immunocytochemistry (ICC) and future directions of cytopathology in the immunotherapy setting.
Collapse
Affiliation(s)
- Eva Tejerina
- Department of Pathology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Laura Garca Tobar
- Department of Pathology, Clinica University of Navarra, Pamplona, Spain
| | - Jos I Echeveste
- Department of Pathology, Clinica University of Navarra, Pamplona, Spain
| | | | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Mara D Lozano
- Department of Pathology, Clinica University of Navarra, Pamplona, Spain
| |
Collapse
|
13
|
Fang Y, Cheng L, Guo J, Wu C, Gu Y, You X, Sha W. Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess: a case report and literature review. J Cardiothorac Surg 2020; 15:331. [PMID: 33225977 PMCID: PMC7681963 DOI: 10.1186/s13019-020-01360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/05/2020] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to report the experience of diagnosis and treatment of one rare case of mediastinal lymph node tuberculous abscess (MLNTA) using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Case presentation An 18-year-old female patient was hospitalized in the Affiliated Hospital of Xuzhou Medical University in November 2017, due to intermittent left chest pain. She was suspected of infecting tuberculosis (TB) and thus received anti-TB treatment. Since April 1, 2018, she began to exhibit symptoms of chest distress. The patient was then admitted to Shanghai Pulmonary Hospital and continued receiving systemic anti-TB treatment during the whole course. On April 11, 2018, she received EBUS-TBNA to puncture pus and inject isoniazid. Simultaneously, the pus was sent for cytopathological and bacteriological examination, both supporting the diagnosis of TB in the patient. On April 24 and May 10, she received two times of EBUS-TBNA treatment. The symptoms of chest distress were relieved, but granulomatous neoplasm occurred at the EBUS-TBNA site on the trachea wall. The patient then received local clamp removal and cryotherapy on May 29 and Jul 19, respectively. Chest computed tomography (CT) reexamination on September 28 revealed that the MLNTA lesion had been completely absorbed, and electronic bronchoscopic reexamination on September 30 demonstrated that the granulomatous neoplasm on the trachea wall was entirely invisible. Conclusions Using EBUS-TBNA to puncture and aspirate pus and inject drugs can be effectively used to diagnose and treat MLNTA, which provides a new, less invasive, safe and reliable method for diagnosis and treatment of MLNTA.
Collapse
Affiliation(s)
- Yong Fang
- Clinic and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P.R. China
| | - Liping Cheng
- Clinic and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P.R. China.
| | - Junhong Guo
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Ye Gu
- Department of Endoscope, Shanghai Pulmonary Hospital, Tongji University Schoo1 of Medicine, Shanghai, 200433, P.R. China
| | - Xiaofang You
- Department of Imaging, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P.R. China.
| | - Wei Sha
- Clinic and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, P.R. China.
| |
Collapse
|
14
|
Management guidelines for stage III non-small cell lung cancer. Crit Rev Oncol Hematol 2020; 157:103144. [PMID: 33254035 DOI: 10.1016/j.critrevonc.2020.103144] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
Management of stage III non- small cell lung cancer (NSCLC) is very challenging due to being a group of widely heterogeneous diseases that require multidisciplinary approaches with timely and coordinated care. The standards of care had significant changes over the last couple of years because of the introduction of consolidation therapy with checkpoint inhibitor following concurrent chemo-radiotherapy and the evolving new role of tyrosine kinase inhibitors in the adjuvant setting. The manuscript presents evidence-based recommendations for the workup, staging, treatment and follow up of the various subtypes of stage III NSCLC. The guidelines were developed by experts in various fields of thoracic oncology and guidelines development. The guidelines consider the sequence of interventions and the role of each discipline in the management of the disease taking into account the recent development and included required resources to help physicians provide better care.
Collapse
|
15
|
Smith AP, Dueber JC, Allison DB. A diagnostic review of carcinomas and sarcomas of the mediastinum: making the diagnosis on fine-needle aspiration and core needle biopsy specimens. Semin Diagn Pathol 2020; 37:187-198. [PMID: 32532552 DOI: 10.1053/j.semdp.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
The mediastinum is a complex anatomic region that can pose many diagnostic challenges on fine-needle aspiration (FNA) and core needle biopsy (CNB). With the recent technological advancements in EBUS-TBNA and EUS-guided procedures, FNA/CNB is being increasingly utilized to obtain the initial and, in many cases, the only diagnosis. As a result, it is imperative to have an understanding of the pearls and pitfalls associated with both the more common and rarer malignancies that occur at this site. Although the vast majority of mediastinal malignancies encountered in routine clinical practice are metastatic carcinomas to mediastinal lymph nodes, primary tumors and tumors that directly extend into the mediastinum are also encountered. As always, a multimodal approach with clinical and radiographic correlation, a targeted IHC panel, and molecular testing when indicated are indisposable and necessary tools in the diagnostic workup of mediastinal malignancies. This review focuses on the salient diagnostic features of malignancies of epithelial and mesenchymal origin, excluding tumors of neurogenic, thymic, hematolymphoid, and germ cell origins, which are discussed in separate articles of this issue.
Collapse
Affiliation(s)
- Alexander P Smith
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Julie C Dueber
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Derek B Allison
- Department of Pathology and Laboratory Medicine, Markey Cancer Center, University of Kentucky, 800 Rose Street, MS 117, Lexington, KY 40536, USA.
| |
Collapse
|
16
|
Abedini A, Razavi F, Mehravaran H, Toutkaboni MP, Kashefizadeh A, Emami H, Kazempour-Dizaji M, Farahani M, Kiani A. Identification of Sonographic Features for Predicting Benign Versus Malignant Mediastinal or Hilar Lymph Nodes Using Endobronchial Ultrasound. Oman Med J 2020; 35:e112. [PMID: 32405434 PMCID: PMC7199125 DOI: 10.5001/omj.2020.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/21/2019] [Indexed: 12/25/2022] Open
Abstract
Objectives In countries with a high prevalence of tuberculosis, such as Iran, the differentiation of malignant from non-malignant tumors is crucial. We attempted to find a reliable model in determining malignant nodes by investigating the sonographic characteristics of lymph nodes (LNs). Methods In this prospective study, the morphologic characteristics of LNs, including size, shape, vascular pattern, echogenicity, margin, coagulation necrosis sign, calcification, and central hilar structure, which had been obtained during endobronchial ultrasound-guided transbronchial needle aspiration, were compared with the final pathology results. Results We examined 253 LNs from 93 patients. Round shape, non-hilar vascular pattern, heterogeneous echogenicity, hyperechogenicity, distinct margin, and the existence of necrosis signs were significantly higher in malignant nodes. On the other hand, the existence of calcification, as well as the presence of central hilar structure, were highly suggestive of benign nodes (p < 0.050). Multivariate logistic regression revealed that size > 1 cm, heterogeneous echogenicity, hyperechogenicity, the existence of necrosis signs, and the lack of central hilar structure are independent predictive factors for malignancy. The accuracy of each of the aforementioned characteristics are 42.3%, 71.5%, 71.9%, 73.5%, and 65.6%, respectively. Of 74 malignant LNs, 100% had at least one of these independent factors. Conclusions The morphological features of LNs based on endobronchial ultrasound-guided transbronchial needle aspiration can play a role in predicting malignancy.
Collapse
Affiliation(s)
- Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Razavi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Mehravaran
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mihan Pourabdollah Toutkaboni
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Kashefizadeh
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Kazempour-Dizaji
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Farahani
- Departemant of Interventional Pulmonology, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|