Procedures: Unique Investigations in Interventional Pulmonology |

Intraoperative Frozen Section of Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA) Specimens FREE TO VIEW

Bernard Kim, MD; Darling Ruiz Cerrato, MD; Kala Davis-McDonald, MD
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Saint Agnes Hospital, Baltimore, MD

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1047A. doi:10.1016/j.chest.2016.08.1153
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SESSION TITLE: Unique Investigations in Interventional Pulmonology

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 02:45 PM - 04:15 PM

PURPOSE: To investigate a novel method of processing specimens obtained in the operating room by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) which utilizes intraoperative consultation and frozen section (cryosection) to provide a rapid pathologic diagnosis. The frozen section process consists of embedding the specimen in Optimal Cutting Temperature (OCT) compound, freezing to -30C in liquid nitrogen and sectioning the block in a Leica CM1860UV cryostat to a thickness of 5 micrometers. The sections are then stained and mounted on slides for microscopic analysis. This technique allows for histopathologic analysis of intact tissue rather than aggregated cells in a cytologic sample, as in rapid on-site cytologic evaluations (ROSE) that are commonly used for EBUS-TBNA samples.

METHODS: Retrospective chart review of adult patients who underwent EBUS-TBNA performed by 2 attending pulmonologists at a 300-bed community teaching hospital in Baltimore from August 2013 to September 2015. We identified all EBUS cases which utilized the intraoperative consultation with frozen section. Patient demographics, details and indications for the procedure were collected. Pathology reports were reviewed for intraoperative diagnosis and final pathologic diagnosis and analyzed for strength of correlation between the two diagnoses using the kappa coefficient.

RESULTS: We identified a total of 56 EBUS cases with a total of 60 individual specimens which were sent for intraoperative consultation. Of these, 43 specimens were analyzed by frozen section and 17 specimens were analyzed by touch prep only. The kappa coefficient was 0.854 indicating an almost perfect correlation between intraoperative diagnosis and final diagnosis.The sensitivity and specificity of intraoperative consultation for diagnosing lung cancer was 85%% and 100%, respectively. Using intraoperative consultation, a total of 22 specimens contained cancerous cells: 17 non-small cell cancers and 5 small cell cancers. Other diagnoses included granuloma (2), atypical cells (5), lymphoma (1), melanoma (1), seminoma (1) and benign lymphoid tissue (14).

CONCLUSIONS: Intraoperative consultation with frozen section is an alternative to rapid on-site cytologic evaluation of specimens obtained by EBUS-TBNA with excellent correlation to final pathologic diagnosis. The sensitivity and specificity in the diagnosis of lung cancer diagnosis is very high and comparable to previously reported yields for EBUS-TBNA.

CLINICAL IMPLICATIONS: At institutions which may not have the personnel to have a dedicated attending pathologist available in the operating suite to provide ROSE, frozen section may be an attractive alternative because it uses existing methods commonly in use at most community hospitals to transport fresh tissue specimens from the site of acquisition, in the OR or bronchoscopy suite, to the hands of an attending pathologist to make a rapid and accurate pathologic diagnosis during the EBUS procedure. The advantage of our technique is the ability to perform more detailed histologic evaluations in the pathology lab rather than being limited to cytologic evaluations offered by ROSE and minimizes time spent by the pathologist waiting for cellular material to examine.

DISCLOSURE: The following authors have nothing to disclose: Bernard Kim, Darling Ruiz Cerrato, Kala Davis-McDonald

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