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Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure. This procedure is useful for nodal staging of lung cancer, evaluating mediastinal lymphoma and granuloma. We retrospectively analyzed our experience with EBUS-TBNA. A total of 232 LNs/masses (112 patients) were examined in this study, including 61 patients with clinical suspicion of sarcoidosis. Of the later 61 patients, non-necrotizing granulomas were identified in 42 patients by EBUS-TBNA. Cell blocks prepared from all 42 patients contained diagnostic material; in contrast, smears from only 10 patients contained granulomas. Five granulomas were positive for acid-fast stain, confirmed by culture and/or tissue biopsy. The remaining 37 granulomas were confirmed to be sarcoidosis clinically. Among the 112 patients, 21 non-small cell carcinomas were diagnosed by EBUS-TBNA. However, smears alone could only reliably differentiated squamous cell carcinoma from adenocarcinoma in 5 cases. Cell blocks and H&E stains clearly differentiated other 6 cases. In the remaining 10 tumors, immunostains in the cell blocks showed: adenocarcinomas were TTF-1+, p63-; squamous cell carcinomas were TTF- 1-, p63+ and CK5/6+. We also compared EBUS-TBNA results in the first 8 months to those in the second 8 months. In the first 8 months, 33 LN/masses were biopsied. Tumor diagnoses were made in 9% of the cases (3 LNs/masses). Material was adequate for cell block in 42% of cases. Subsequent tissue diagnoses were available in 50% of cases, 33% EBUS-TBNA tumor diagnoses was confirmed histologically. In the second 8 months, 79 LNs were sampled. Tumor/granuloma diagnoses were achieved in 27% of the cases (21 nodes, P=0.045). Material was adequate for cell block in 90% of cases (P<0.001). Corresponding tissue diagnoses were available in 28% of cases, 100% tumor/granuloma diagnoses were confirmed histologically (P=0.01). Our findings showed the critical role of cell block preparation in diagnosis of granulomatous diseases and differential diagnosis of non-small cell carcinomas. In addition, a steep learning curve should be expected when EBUS-TBNA was first adopted.

Biography

He Wang completed his medical degree from China Medical University and received his Ph.D. from McGill University, Canada. He finished his anatomic pathology residency training at University of Michigan, Ann Arbor, surgical pathology fellowship at Massachusetts General Hospital/Harvard University, Boston, and cytopathology fellowship at Hospital of University of Pennsylvania. He is now Assistant Professor of Pathology and Lab Medicine at Temple University School of Medicine. He has published more than 30 peer-reviewed papers and served as reviewers for several reputed journals.