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Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study
Author(s) -
Nambirajan Aruna,
Longchar Moanaro,
Madan Karan,
Mallick Saumya Ranjan,
Kakkar Aanchal,
Mathur Sandeep,
Jain Deepali
Publication year - 2019
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12656
Subject(s) - medicine , malignancy , lymphoma , radiology , mediastinal lymphadenopathy , cytopathology , fine needle aspiration , cytology , lymph node , metastasis , pathology , biopsy , cancer
Background Endobronchial ultrasound‐guided transbronchial needle aspiration ( EBUS ‐ TBNA ) is the primary modality for mediastinal lymph node staging in lung carcinoma. We aimed to evaluate its utility in extra‐pulmonary malignancies ( EPM ). Methods Database search of EBUS ‐ TBNA aspirations (2013‐2017) done in patients with known/suspected EPM s and mediastinal lymphadenopathy/masses was performed. All archived cytology/histology material was reviewed and categorised as positive, negative and unsatisfactory. Results The selected 139 patients included 100 patients with known EPM s, 11 patients with known lymphoma, and 28 patients with suspected EPM of unknown primary. EBUS ‐ TBNA was adequate in 110 patients (79%), including 21 patients who yielded only reactive lymphoid tissue. Satisfactory blood clot cores were obtained in 34 patients and contributed significantly to diagnosis and ancillary testing. Metastasis was detected in 45 patients with known EPM , predominantly originating from a known primary in the breast in females (56%) and squamous cell carcinomas of head and neck in males (60%). Granulomatous lymphadenopathy was identified in 16 patients with known EPM (16%). Lymphoma relapse and granulomatous lymphadenopathy were identified in three and four patients with known lymphoma, respectively. In patients with suspected EPM of unknown primary site, malignancy was confirmed in 21 patients, predominantly representing metastatic adenocarcinomas (n = 5) and neuroendocrine neoplasms (n = 5). Immunocytochemistry was performed in 16 of these cases and aided in characterisation of primary site/type of tumour in 12 cases. Conclusion EBUS ‐ TBNA is efficient for screening mediastinal lymph nodes/masses for malignancy in EPM s. Procuring sufficient material for ancillary testing would improve diagnostic accuracy and reduce need for resampling.