Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens

Adrienne Carruth Griffin, Lauren Ende Schwartz, Zubair W Baloch, Adrienne Carruth Griffin, Lauren Ende Schwartz, Zubair W Baloch

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an integral tool in the diagnosis and staging of malignant tumors of the lung. Rapid on-site evaluation (ROSE) of fine needle aspiration (FNA) samples has been advocated for as a guide for assessing the accuracy and adequacy of biopsy samples. Although ROSE has proven useful for numerous sites and procedures, few studies have specifically investigated its utility in the assessment of EBUS-TBNA specimens. The intention of this study was to explore the utility of ROSE for EBUS-TBNA specimens.

Materials and methods: The pathology files at our institution were searched for all EBUS-TBNA cases performed between January 2010 and June 2010. The data points included number of sites sampled per patient, location of site(s) sampled, on-site evaluation performed, preliminary on-site diagnosis rendered, final cytologic diagnosis, surgical pathology follow-up, cell blocks, and ancillary studies performed.

Results: A total of 294 EBUS-TBNA specimens were reviewed and included in the study; 264 of 294 (90%) were lymph nodes and 30 of 294 (10%) were lung mass lesions. ROSE was performed for 140 of 294 (48%) specimens. The on-site and final diagnoses were concordant in 104 (74%) and discordant in 36 (26%) cases. Diagnostic specimens were obtained in 132 of 140 (94%) cases with on-site evaluation and 138 of 154 (90%) without on-site evaluation. The final cytologic diagnosis was malignant in 60 of 132 (45%) cases with ROSE and 46 of 138 (33%) cases without ROSE, and the final diagnosis was benign in 57 of 132 (47%) with ROSE and 82 of 138 (59%) without ROSE. A cell block was obtained in 129 of 140 (92%) cases with ROSE and 136 of 154 (88%) cases without ROSE.

Conclusions: The data demonstrate no remarkable difference in diagnostic yield, the number of sites sampled per patient, or clinical decision making between specimens collected via EBUS-TBNA with or without ROSE. As a result, this study challenges the notion that ROSE is beneficial for the evaluation of EBUS-TBNA specimens.

Keywords: EBUS-TBNA; ROSE; endobronchial; on-site.

References

    1. Chin R, Jr, McCain TW, Lucia MA, Cappellari JO, Adair NE, Lovato JF, et al. Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed? Am J Respir Crit Care Med. 2002;166:377–81.
    1. Khazai L, Kundu UR, Jacob B, Patel S, Sneige N, Eapen GA, et al. Endobronchial ultrasound-guided transbronchial needle aspiration biopsy is useful evaluating mediastinal lymphadenopathy in a cancer center. Cytojournal. 2011;8:10.
    1. Alsharif M, Andrade RS, Groth SS, Stelow EB, Pambuccian SE. Endobronchial ultrasound-guided transbronchial fine-needle aspiration: the University of Minnesota experience, with emphasis on usefulness, adequacy assessment, and diagnostic difficulties. Am J Clin Pathol. 2008;130:434–43.
    1. Nayak A, Sugrue C, Koenig S, Wasserman PG, Hoda S, Morgenstern NJ. Endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA): A proposal for on-site adequacy criteria. Diagn Cytopathol. 2010 [In Press]
    1. Feller-Kopman D, Yung RC, Burroughs F, Li QK. Cytology of endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective study with histology correlation. Cancer. 2009;117:482–90.
    1. Diacon AH, Schuurmans MM, Theron J, Louw M, Wright CA, Brundyn K, et al. Utility of rapid on-site evaluation of transbronchial needle aspirates. Respiration. 2005;72:182–8.
    1. Diette GB, White P, Jr, Terry P, Jenckes M, Rosenthal D, Rubin HR. Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. Chest. 2000;117:1186–90.
    1. Tournoy KG, Praet MM, Van Maele G, Van Meerbeeck JP. Esophageal endoscopic ultrasound with fine-needle aspiration with an on-site cytopathologist: high accuracy for the diagnosis of mediastinal lymphadenopathy. Chest. 2005;128:3004–9.
    1. Klapman JB, Logrono R, Dye CE, Waxman I. Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol. 2003;98:1289–94.
    1. Jhala NC, Jhala DN, Chhieng DC, Eloubeidi MA, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration.A cytopathologist's perspective. Am J Clin Pathol. 2003;120:351–67.
    1. Fassina A, Corradin M, Zardo D, Cappellesso R, Corbetti F, Fassan M. Role and accuracy of rapid on-site evaluation of CT-guided fine needle aspiration cytology of lung nodules. Cytopathology. 2011;22:306–12.
    1. Genta F, Zanon E, Camanni M, Deltetto F, Drogo M, Gallo R, et al. Cost/accuracy ratio analysis in breast cancer patients undergoing ultrasound-guided fine-needle aspiration cytology, sentinel node biopsy, and frozen section of node. World J Surg. 2007;31:1155–63.
    1. Seethala RR, LiVolsi VA, Baloch ZW. Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of lesions of the parotid gland. Head Neck. 2005;27:217–23.
    1. Tan WJ, Sanghvi K, Liau KH, Low CH. An audit study of the sensitivity and specificity of ultrasound, fine needle aspiration cytology and frozen section in the evaluation of thyroid malignancies in a tertiary institution. Ann Acad Med Singapore. 2010;39:359–62.
    1. Zbaren P, Guelat D, Loosli H, Stauffer E. Parotid tumors: fine-needle aspiration and/or frozen section. Otolaryngol Head Neck Surg. 2008;139:811–5.
    1. Monaco SE, Schuchert MJ, Khalbuss WE. Diagnostic difficulties and pitfalls in rapid on-site evaluation of endobronchial ultrasound guided fine needle aspiration. Cytojournal. 2010;7:9.
    1. Davenport RD. Rapid on-site evaluation of transbronchial aspirates. Chest. 1990;98:59–61.
    1. Woon C, Bardales RH, Stanley MW, Stelow EB. Rapid assessment of fine needle aspiration and the final diagnosis--how often and why the diagnoses are changed. Cytojournal. 2006;3:25.
    1. Factor R, Layfield LJ. Intraprocedural evaluation of fine-needle aspiration smears: How good are we? Diagn Cytopathol. 2011 [In Press]
    1. Gilbert S, Wilson DO, Christie NA, Pennathur A, Luketich JD, Landreneau RJ, et al. Endobronchial ultrasound as a diagnostic tool in patients with mediastinal lymphadenopathy. Ann Thorac Surg. 2009;88:896–900. discussion 901-2.
    1. Jacob-Ampuero MP, Haas AR, Ciocca V, Bibbo M. Cytologic accuracy of samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration at Thomas Jefferson University Hospital. Acta Cytol. 2008;52:687–90.
    1. Trisolini R, Cancellieri A, Tinelli C, Paioli D, Scudeller L, Casadei GP, et al. Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy: a randomized trial. Chest. 2011;139:395–401.
    1. Schwartz LE, Griffin AC, Baloch Z. Cell block interpretation is helpful in the diagnosis of granulomas on cytology. Diagn Cytopathol. 2011 Jun 21; doi: 101002/dc21761.
    1. Al-Abbadi MA, Bloom LI, Fatheree LA, Haack LA, Minkowitz G, Wilbur DC, et al. Adequate reimbursement is crucial to support cost-effective rapid on-site cytopathology evaluations. Cytojournal. 2010;7:22.
    1. Dhillon I, Pitman MB, Demay RM, Archuletta P, Shidham VB. Compensation crisis related to the onsite adequacy evaluation during FNA procedures-Urgent proactive input from cytopathology community is critical to establish appropriate reimbursement for CPT code 88172 (or its new counterpart if introduced in the future) Cytojournal. 2010;7:23.
    1. Gupta PK. Progression from on-site to point-of-care fine needle aspiration service: Opportunities and challenges. Cytojournal. 2010;7:6.
    1. Layfield LJ, Bentz JS, Gopez EV. Immediate on-site interpretation of fine-needle aspiration smears: a cost and compensation analysis. Cancer. 2001;93:319–22.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa