The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience

Our plain-English summary of The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience, by S. Natu, J. Hoffman, M. Siddiqui, et al (Journal of Clinical Pathology, 2010).

The study

• Authors: S. Natu, J. Hoffman, M. Siddiqui, C. Hobday, J. Shrimankar, R. Harrison
• Journal: Journal of Clinical Pathology
• Published: 2010;63(5):445-51
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: To assess the diagnostic role of endobronchial ultrasound (EBUS) guided transbronchial fine needle aspiration (TBNA) cytology, in the investigation of mediastinal lymphadenopathy and masses, with emphasis on pathology, criteria for adequacy, and use of liquid based cytology (LBC).

Methods: In January 2008, EBUS guided TBNA was introduced for the staging of lung cancers and for the investigation of unexplained mediastinal lymphadenopathy and masses. Initially, the material was processed conventionally. In May 2008, the laboratory procured the Cytyc T2000.

Results: 250 specimens (229 patients) were included from January 2008 to August 2009. The overall inadequate rate was 12%; 16.6% with the conventional method, 17.2% when both conventional and LBC were used, and 9.8% with LBC. With the conventional method, an average of 7.5 slides and one cell block were received per case. With LBC, one slide and one cell block were used for diagnosis. In 72 cases (28.8%) the aspirate showed no evidence of malignancy. In 122 cases (48.8%), there was metastatic disease. In five cases (2%), a diagnosis of atypia, suspicious for non-small cell malignancy, was made. One case (0.4%) each of amyloidosis and mediastinal goitre, 3 cases (1.2%) of lymphoma, 14 cases (5.6%) of sarcoidosis and 1 case (0.4%) each of sarcoma and mesothelioma were seen.

Conclusions: EBUS guided TBNA, in our experience, is a reliable technique for staging of lung cancers, and investigation of unexplained mediastinal lymphadenopathy and masses. LBC reduces the number of slides from 7.5 per case to 1 slide, reducing time required for diagnosis.

In plain English

This article reported one UK hospital's experience with endobronchial ultrasound guided needle aspiration (EBUS-TBNA), a way of sampling chest lymph nodes and masses through the airway. The study was at the University Hospital of North Tees from January 2008 to August 2009 and covered 250 specimens from 229 patients, mostly people being staged for lung cancer. Specimens were first processed as conventional smears and, from May 2008, by liquid based cytology, which cut slides per case from an average of 7.5 to one. The overall inadequate rate was 12%: 16.6% with the conventional method, 17.2% when both methods were used, and 9.8% with liquid based cytology. The authors linked this fall to growing experience. Metastatic disease was found in 48.8% of cases. One case of metastatic mesothelioma was found, and the article does not say where it began. Asbestos appeared only in a figure caption describing an atypical squamous cell next to an asbestos body. The authors concluded the technique was reliable, but said their data did not allow a true comparison of the two processing methods.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-hospital case series reviewing diagnostic specimens over 20 months
• Who was studied: 250 specimens from 229 patients (132 male, 97 female) sampled at the University Hospital of North Tees, Stockton, UK, from January 2008 to August 2009. Most procedures were for lung cancer staging. In 19 cases the procedure was used to diagnose unexplained mediastinal lymphadenopathy or a mass.
• Exposure: No asbestos or other exposure was assessed. The study examined a diagnostic procedure (EBUS guided TBNA) and two ways of processing the samples: conventional smears before May 2008, and liquid based cytology (Cytyc T2000, ThinPrep) after that.
• Main results:
  • The overall inadequate rate was 12%: 16.6% with the conventional method, 17.2% when both conventional and liquid based cytology were used, and 9.8% with liquid based cytology alone.
  • The authors considered adequacy independent of the T2000 processor, since rates were similar with conventional processing and during the combined phase.
  • With the conventional method an average of 7.5 slides and one cell block were received per case. With liquid based cytology one slide and one cell block were used.
  • Of all cases, 72 (28.8%) showed no evidence of malignancy and 122 (48.8%) showed metastatic disease.
  • Other diagnoses included 14 cases (5.6%) of sarcoidosis and 3 cases (1.2%) of lymphoma.
  • One case of metastatic mesothelioma was diagnosed in a lymph node sample. The article does not state the primary site or give any exposure history.
  • A figure caption describes an atypical squamous cell next to an asbestos body. The article gives no further details about this case.
• The authors' conclusion: The authors concluded that EBUS guided TBNA, in their experience, is a reliable technique for staging lung cancers and for investigating unexplained mediastinal lymphadenopathy and masses. They also concluded that liquid based cytology reduces the number of slides needed.
• Limitations the authors state:
  • The data were not standardised, so the authors said the two processing techniques could not be truly compared.
  • Microbiological culture for tuberculosis and flow cytometry for suspected lymphoma were not done in this case series.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Ultrasound, Cytology, Lymphadenopathy, Pathology, Staging, Lung Cancer, Cell Block, Aspirate.

Related studies

• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma — J. Hamamoto, D. Notsute, et al. (2010)
• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)
• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)

Browse more research in Journal of Clinical Pathology, or return to medical research.