Pulmonary Procedures |

The Utility of EBUS-TBNA in Diagnosing Hodgkin's Lymphoma FREE TO VIEW

Sonali Sethi, MD; Michael Machuzak, MD; Francisco Almeida, MD; Thomas Gildea, MD; Peter Mazzone, MD; Atul Mehta, MD; Jinesh Patel, MD; Joseph Cicenia, MD
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Cleveland Clinic, Cleveland, OH

Chest. 2013;144(4_MeetingAbstracts):795A. doi:10.1378/chest.1703888
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Historically, diagnostic accuracy of EBUS-TBNA for solid tumors is well above 90%, though its utility is not as appreciable for diagnosing lymphoproliferative disorders. In the small number of studies utilizing EBUS for the diagnosis of lymphoproliferative disorders, the number of patients diagnosed with Hodgkin’s lymphoma (HL) is between 2-3 patients per study. We reviewed our clinical experience to examine the clinical use of EBUS-TBNA in patients with mediastinal lymphadenopathy secondary to HL.

METHODS: A retrospective review was performed on all patients diagnosed with HL at our institution between 1/2007-2/2013. Inclusion criteria were any patient diagnosed with HL in which an EBUS-TBNA was performed prior to obtaining a diagnosis. For every patient, the age, gender, adenopathy demographics, clinical symptoms, and reason for EBUS-TBNA were recorded.

RESULTS: There were a total of 252 patients diagnosed with Hodgkin’s lymphoma over a 6 year period. Of these patients, 15 had an EBUS-TBNA bronchoscopy performed prior to diagnosis (6%). One patient had a previous history of HL. Adequate lymphoid tissue was obtained by EBUS-TBNA in 13/15 patients (87%). Twenty-nine lymph nodes were sampled in total (average 1.93 per patient). Lymph node size varied from 10.2 - 63 mm. Six patients (40%) who underwent an EBUS-TBNA were definitively diagnosed with HL based on cytology. All cases were confirmed with a surgical biopsy for further subclassification. Of the remaining nine patients (60%), 2 patients did not have adequate lymphoid tissue, 5 patients had atypical lymphoid cells suspicious for lymphoma, 1 patient had granulomatous inflammation, and 1 patient had benign lymphoid tissue. In all nine patients, surgical biopsy was pursued based on atypical radiographic findings, atypical lymphocytes on cytology, or clinical presentation.

CONCLUSIONS: There is value in performing EBUS-TBNA in patients with undiagnosed HL. Although previously unreported, our data shows a 40% yield using EBUS-TBNA. EBUS-TBNA does not allow histological subtyping, however current evidence suggests diminishing value in cell histology and more importance on staging HL.

CLINICAL IMPLICATIONS: EBUS-TBNA is a viable test for the diagnosis of mediastinal Hodgkin's lymphoma.

DISCLOSURE: The following authors have nothing to disclose: Sonali Sethi, Michael Machuzak, Francisco Almeida, Thomas Gildea, Peter Mazzone, Atul Mehta, Jinesh Patel, Joseph Cicenia

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