Endobronchial Ultrasound (EBUS) guided Transbronchial Needle-aspiration (TBNA) is useful in diagnosis of thoracic adenopathy. However non-diagnostic TBNA or findings of benign lymphocytes often prompt more invasive procedures. We review whether EBUS images features (septation), and sample collection as histology clot, can improve diagnosis of benign adenopathy and obviate further medianstinoscopies or surgeries.
EBUS-TBNA performed with 22 gauge Vizishot needle using (OlympusBFUC180F) Convex-probe on 36 patients (22 males, 14 females), average age 60.8 (range 31–94) with 47 lymph nodes (LNs), size average 1.47 cm range 0.7–3.2 cm). We note the ultrasonographic characteristics on EBUS examination, especially for Intra-nodal Septations. Specimen collected with 10–20 cc negative pressure aspiration. Instead of routinely flushing all cells onto slides or into saline, the thin-wire needle trocar is used to push cells onto filter papers to create coagulum-clots for histology, routine smears are also prepared.
Biopsy results: Overall Cytology Malignant in 13(28%), Benign in 27(57%)-10 granulomatous. Non-diagnostic in 7(15%). A histology clot was successfully acquired from 26/47 LNs in 25/36 patients; average LN size 1.6 cm, average number of passes 4, histology results: malignant in 10(39%) Benign in 9(35%)-4 granulomatous. Non-diagnostic in 7(26%). Ultrasonographic characteristics of EBUS images in 47 LNs, septation observed in 13 LNs(12 patients). Results of EBUS-TBNA cytology: benign in 13 LNs (100%), including 7 granulomatous (53.8%). 3/13 had follow-up surgeries or post-mortem, remainder clinically followed. No malignant nodes had septations.
Intra-nodal septations seen by EBUS has a high negative-predictive value for malignant involvement. Not all EBUS-TBNA attempts yielded adequate specimen for coagulum clot for histology (9/27), but when findings of septations and/or absence of cancer cells in a histology-clot specimen are combined, we would have correctly identified 20/27 benign lymph nodes.
EBUS provides ultrasonographic characterization and Real-time Image Guidance for targeted sampling of LNs suspicious for malignancies. By incorporating findings of certain benign features (septations) and benign lymphocytes in coagulum-clot histology, more invasive follow-up biopsies may be deferred and spare patients potential surgical complications.
Ola Abdel-Rehim, No Financial Disclosure Information; No Product/Research Disclosure Information