SESSION TITLE: EBUS and Image-Guided Bronchoscopy
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM
PURPOSE: The optimization of specimen handing during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is important to achieve high diagnostic yield as well as maximize the samples for molecular testing. The histological core can be obtained by EBUS-TBNA and there are several acquisition and preparation methods for the EBUS-TBNA core specimen. The aim of this study is to compare the two different sample processing methods; 1) tissue coagulation clot (TCC) and 2) liquid base cytology (LBC), to develop the optimal specimen handling protocol for EBUS-TBNA.
METHODS: From March to December 2013, we processed EBUS-TBNA specimens as follows; 1) the specimen from initial puncture was collected using TCC, 2) the specimen from the second puncture was collected using LBC. We used the dedicated 22-gauge needle for EBUS-TBNA. If there were no tissue core for the first puncture, the lymph node was excluded from this study. The histoloical cores were evaluated pathologically by an independent pathologist. We retrospectively analyzed for the quantity as well as quality of the specimen, in addition to the diagnostic yield. We also examined the detection rate for EGFR mutation for both TCC and LBC using PCR-clamp method if the sample was diagnosed as adenocarcinoma.
RESULTS: 60 patients (108 lymph nodes) were enrolled. An indication for EBUS-TBNA was as follows; 51 lung cancer or suspicious for lung cancer cases (including 10 post-operative cases and 3 post induction treatment cases), four cases with extrathoracic malignancies and sarcoidosis, and one case with malignant mesothelioma. Sufficient material for diagnosis were obtained for; 97 samples for cytology (89.8%), 91 samples for TCC (84.3%), and 97 samples for LBC (89.8%), respectively. Sensitivity, negative predictive value, and diagnostic accuracy were; 1) 78.3%, 83.6%, 89.7% for cytology, 2) 88.9%, 90.2%, 94.5% for TCC, and 3) 87.5%, 89.1%, 93.8% for LBC. Immunohistochemistry was performed for 16 LBC samples and the quality of immunohistochemistry was equal to TCC samples. For EGFR mutation testing, the mutation was equally detected from both TCC and LBC.
CONCLUSIONS: There was no significant difference between TCC and LBC for the diagnostic yield; however, sufficient materials for diagnosis was more frequently obtained using LBC (p<0.01).
CLINICAL IMPLICATIONS: By the use of LBC, we may have a greater chance to perform histological diagnosis including immunohistochemistry. LBC may also increase the chance of molecular testing using EBUS-TBNA samples.
DISCLOSURE: The following authors have nothing to disclose: Takahiro Nakajima, Terunaga Inage, Fumie Saegusa, Syoji Ooki, Junichi Morimoto, Kaoru Nagato, Hidemi Suzuki, Takekazu Iwata, Shigetoshi Yoshida, Yukio Nakatani, Ichiro Yoshino
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