PURPOSE: The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of lymphoma is not well defined. For Hodgkin’s Lymphoma (HL), a fine needle aspirate (FNA) is thought to be lacking information on the structural composition of the lymph node while for non-Hodgkin’s (NHL) a tissue biopsy is recommended following a suggestive FNA.
METHODS: Chart review of all EBUS-TBNA performed by one operator at the same institution and assessment of the different diagnoses and follow up.
RESULTS: Over a period of 25 months, 138 EBUS-TBNA were performed. Malignancy was identified in 77/138 (55.8%). Of those, 68 (88.3%) were primary lung malignancies (64 small cell and 4 non-small cell), 2 were identified as renal cell, one was identified as cervical cancer metastasis and one was metastatic colon cancer. Four were identified as lymphoma (three NHL and one HL). Granulomatous inflammation was identified in 18/138 (13%) and 43/138 (31.2%) were non-diagnostic. The median follow up for patients with non-diagnostic specimen was 13 months. Of the lymphoma diagnoses, one identified a NHL recurrence and no further confirmation was sought. The other three were confirmed by tissue biopsy (mediastinoscopy and cervical node biopsy). Flow cytometry was used and confirmed the diagnosis in 4 and was the only positive in one.
CONCLUSION: Over a 25 months period, a single operator at one institution identified lymphoma as a diagnosis from EBUS-TBNA in 2.9% of cases and 5.2% of malignant diagnoses. Flow cytometry confirmed diagnosis in all four cases whereas cytology was negative in one.
CLINICAL IMPLICATIONS: EBUS-TBNA is helpful in diagnosing lymphoma especially when combined with flow cytometry. Additional tissue biopsy may not be warranted in the setting of recurrent disease. For initial diagnoses, our institution follows the recommendation to confirm a "suggestive" FNA with a tissue biopsy. Further studies with larger numbers may need to be performed to establish mediastinal FNA as a final diagnostic measure for lymphoma.
DISCLOSURE: Sapna Bhatia, No Financial Disclosure Information; No Product/Research Disclosure Information