Pulmonary Procedures |

Endobronchial Ultrasound Guided Transbronchial Needle Aspiration: Core vs. Traditional Needle Tissue Acquisition in the Age of Cytogenetics FREE TO VIEW

Roshen Mathew, MD; Chirag Shah, MD; Maria del Mar Cirino-Marcano, MD; Sean Stoy, MD
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AECOM, Montefiore Medical Center, Bronx, NY

Chest. 2015;148(4_MeetingAbstracts):827A. doi:10.1378/chest.2221682
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SESSION TITLE: Interventional Pulmonology Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is traditionally performed to acquire tissue from mediastinal and hilar nodes. It is unknown if core biopsy needles for EBUS-TBNA are comparable to traditional needles.

METHODS: Retrospective review of 159 EBUS-TBNA cases performed with rapid onsite evaluation (ROSE) using either a standard Mediglobe SonoTip II EBUS 22G needle (MGE), or a Cook Echotip Procore (22/25G) EBUS needle with core biopsy capability at a tertiary care medical center between 2013 and 2014. Data was evaluated for adequacy of cytology specimens during ROSE, final yield for cytopathology via FNA and cellblock, blood contamination, and yield of the TBNA specimen for the ability to test for lung cancer cytogenetics.

RESULTS: Mean age and sex were not statistically significant. Ethnic group distribution was African American (31%), White (21%) and Hispanic (41%) other groups (7%). Regarding ROSE - with MGE 30 (34%) vs PCE 59 (66%) had satisfactory specimens during assessment. FNA yield - 51% with MGE vs 79% with PCE, P value 0.0003. Diagnosis by cellblock - 22% with MGE vs 60% with PCE, P value <0.0001. Overall EBUS-TBNA sensitivity - 74% with MGE vs 92% with PCE, P value 0.009. Sensitivity for diagnosis of malignancy - 74% with MGE vs 90% with PCE, P value 0.0365. Sensitivity for the diagnosis of granulomatous diseases - 62% with MGE vs 100% with PCE, P value 0.0571. With MGE 5 out of 14 cases (36%), and 14 of 19 cases (74%) with PCE (P value 0.0397) had sufficient material to test for cancer cytogenetics (EGFR, ALK, KRAS). Blood and debris contamination was 27% with MGE vs 30% with PCE (P value 0.72).

CONCLUSIONS: The Cook Procore needle for EBUS-TBNA demonstrated improved yield over a standard needle in testing for malignancy, providing satisfactory material for ROSE, along with providing sufficient material for lung cancer cytogenetics.

CLINICAL IMPLICATIONS: EBUS-TBNA is the first modern choice for mediastinal diagnostics and staging for potential malignancy. At our center, the data supports utilizing a core needle instead of a traditional needle to safely acquire tissue for cytopathology and cytogenetic analyses.

DISCLOSURE: The following authors have nothing to disclose: Roshen Mathew, Chirag Shah, Maria del Mar Cirino-Marcano, Sean Stoy

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