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Pulmonary Procedures |

Tissue Sparing Protocolized Ancillary Testing for EBUS Fine Needle Aspiration Specimens of Suspected Lymphoma

Israa Soghier, MBChB; Vikramjit Mukherjee; Jun-Chieh Tsay; Ravindra Rajmane
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New York University, New York, NY


Chest. 2014;146(4_MeetingAbstracts):740A. doi:10.1378/chest.1992187
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Abstract

SESSION TITLE: EBUS and Advanced Bronchoscopy Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The use of endobronchial ultrasound fine needle aspiration (EBUS-FNA) in the diagnosis of a lymphoproliferative disorder can be challenging. Ancillary studies are increasingly applied to these specimens since the diagnosis is optimally made by larger core biopsy or lymph node excision. We describe a tissue sparing protocol that applies 3 ancillary tests to EBUS specimens: Immunohistochemical Staining, Flow Cytometry and Fluorescence In Situ Hybridization (FISH).

METHODS: This retrospective study reviewed all patients with lymphoma who underwent bronchoscopy with EBUS-FNA at New York University (NYU) and Bellevue Hospital between January 2009 and December 2013. The patients' demographics, size and location of lymph nodes, number of needle passes, and method of cytologic analysis were documented.

RESULTS: A tissue sparing protocol for ancillary testing of cytology specimens was instituted at NYU in 2011. Four patients underwent EBUS-FNA after implementation of this protocol. Three out of 6 patients had lymphoma diagnosed exclusively from an EBUS specimen. One patient was diagnosed by a concomitant transbronchial lung biopsy of a mass performed after implementation of the protocol. The FNA specimen final diagnosis was revised to corroborate the transbronchial biopsy and was deemed diagnostic of lymphoma. The 2 specimens that required mediastinoscopy were performed before protocol implementation. Final cytologic diagnosis included 2 large cell lymphomas, 2 small lymphocytic lymphomas, 1 follicular B cell lymphoma and 1 Hodgkin lymphoma. A mean of 1.5 lymph nodes were aspirated per patient with an average of 3.4 passes per lymph node. Diagnosis was established in 50% with flow cytometry and in 50% with immunohistochemistry. FISH was performed in 2 patients and was not associated with an improvement in diagnostic yield.

CONCLUSIONS: Recognition of lymphoma on cytology can be limited by inaccurate sampling, non-uniform involvement of the tissue sample and small sample size. NYU’s tissue sparing protocol seeks to minimize specimen untilization for nonspecific assays. We have previously shown that this protocol improves the yield of EBUS FNA for diagnosing bronchogenic carcinoma to 77% . It is likely that a combination of ancillary studies that include immunohistochemistry, MIB1, flow cytometry and FISH is required.

CLINICAL IMPLICATIONS: EBUS-FNA is a minimally invasive procedure capable of yielding an accurate diagnosis and subclassification of lymphoma with stream lined, tissue sparing ancillary testing.

DISCLOSURE: The following authors have nothing to disclose: Israa Soghier, Vikramjit Mukherjee, Jun-Chieh Tsay, Ravindra Rajmane

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