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Roberto F. Casal, MD; Gregg A. Staerkel, MD; Rodolfo C. Morice, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Michael E. DeBakey VA Medical Center (Dr Casal); and the Department of Pathology, Division of Anatomic Pathology and Laboratory Medicine (Dr Staerkel), and the Department of Pulmonary Medicine (Dr Morice), The University of Texas MD Anderson Cancer Center.

Correspondence to: Roberto F. Casal, MD, Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Pulmonary Section 111i, Houston, TX 77030; e-mail: casal@bcm.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: This research was supported in part by the National Institutes of Health through a Cancer Center Support Grant [Grant CA016672] to MD Anderson Cancer Center.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):282-283. doi:10.1378/chest.12-2477
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To the Editor:

We thank Drs Madan and Guleria for their comments regarding our study of endobronchial ultrasound (EBUS) performed with and without aspiration.1 Their main question is whether we analyzed the ability to obtain a histologic core with each technique (with and without suction). They base the relevance of the histologic core on the study of Lee et al,2 which showed that obtaining a core in the first or second pass is associated with a high yield, and also on the study of Nakajima et al,3 who performed epidermal growth factor receptor analysis on histologic cores obtained with EBUS. We did not analyze the ability to provide histologic cores for each technique for several reasons. First, it is not our current practice to routinely send “cores” for histology, unless tissue architecture is warranted. After on-site preparation of slides, we routinely place all other material in liquid media for cell-block preparation. Histologic sections of the formed pellet enable cell patterns to be studied and provide enough material for immunohistochemistry and molecular analyses. A “true” tissue core biopsy specimen is only obtained when a sheathed slotted needle is used, which, to date, is not available for EBUS. What Drs Madan and Guleria refer to as “histologic core” is typically a mix of clot and small tissue fragments that look like cores of tissue. Since there is less trauma when no suction is applied, this technique is less likely to provide large visible fragments on glass slides, which, as we mentioned, are mostly blood clots. Of note, the cited article of Lee et al2 obtained histologic cores in 75% of samples, but they were only able to create a cell block in 33% of the samples. It is then just a matter of how the solid or semisolid material obtained with EBUS is analyzed. To the best of our knowledge, there is no study comparing diagnostic yield of histologic core vs cell-block preparations. Although difference in cellularity of cell blocks for each technique was not analyzed in our study, the cell-block results were part of the overall analyses for diagnostic yield, in which we found no differences between the two techniques. Regarding the postulated need to submit a “core” sample to perform molecular testing, there is now robust evidence showing that such analysis can be performed from cell-block samples or microdissection of malignant cells from slides.4,5

Acknowledgments

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Casal RF, Staerkel GA, Ost D, et al. Randomized clinical trial of endobronchial ultrasound needle biopsy with and without aspiration. Chest. 2012;142(3):568-573. [CrossRef] [PubMed]
 
Lee HS, Lee GK, Lee H-S, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-374. [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K, Suzuki M, et al. Assessment of epidermal growth factor receptor mutation by endobronchial ultrasound-guided transbronchial needle aspiration. Chest. 2007;132(2):597-602. [CrossRef] [PubMed]
 
Navani N, Brown JM, Nankivell M, et al. Suitability of endobronchial ultrasound-guided transbronchial needle aspiration specimens for subtyping and genotyping of non-small cell lung cancer: a multicenter study of 774 patients. Am J Respir Crit Care Med. 2012;185(12):1316-1322. [CrossRef] [PubMed]
 
Billah S, Stewart J, Staerkel G, Chen S, Gong Y, Guo M. EGFR and KRAS mutations in lung carcinoma: molecular testing by using cytology specimens. Cancer Cytopathol. 2011;119(2):111-117. [CrossRef] [PubMed]
 

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References

Casal RF, Staerkel GA, Ost D, et al. Randomized clinical trial of endobronchial ultrasound needle biopsy with and without aspiration. Chest. 2012;142(3):568-573. [CrossRef] [PubMed]
 
Lee HS, Lee GK, Lee H-S, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-374. [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K, Suzuki M, et al. Assessment of epidermal growth factor receptor mutation by endobronchial ultrasound-guided transbronchial needle aspiration. Chest. 2007;132(2):597-602. [CrossRef] [PubMed]
 
Navani N, Brown JM, Nankivell M, et al. Suitability of endobronchial ultrasound-guided transbronchial needle aspiration specimens for subtyping and genotyping of non-small cell lung cancer: a multicenter study of 774 patients. Am J Respir Crit Care Med. 2012;185(12):1316-1322. [CrossRef] [PubMed]
 
Billah S, Stewart J, Staerkel G, Chen S, Gong Y, Guo M. EGFR and KRAS mutations in lung carcinoma: molecular testing by using cytology specimens. Cancer Cytopathol. 2011;119(2):111-117. [CrossRef] [PubMed]
 
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