Optimising rapid on-site evaluation-assisted endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes: The real-time cytopathology intervention process

Alexandra M. Danakas, Carolyn E. Jones, Michael Magguilli, Michal J. Lada, John Plavnicky, Shobha Parajuli, Joseph J. Wizorek, Christian G. Peyre, Mark Ettel, Melissa Sweeney, Luis E. De Las Casas

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Lymph node sampling by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the state of art procedure for staging the mediastinum and hilar regions in lung cancer patients. Our experience of implementing the real-time cytopathology intervention (RTCI) process for intraoperative EBUS-TBNAs is presented. This study is aimed to describe in detail the RTCI process for EBUS-TBNAs, and assess its utility and diagnostic yield before and after its implementation in parallel to conventional rapid on-site evaluation (c-ROSE). Methods: A retrospective review of all EBUS-TBNAs between July 2016 and July 2017 at the University of Rochester Medical Center was performed. Final diagnoses, patient clinical data, and number of non-diagnostic samples (NDS) were reviewed. The numbers of NDS obtained from EBUS-TBNAs with no cytology assistance (NCA), with RTCI and with c-ROSE were analysed. Results: Non-diagnostic lymph node samples were found in 20 out of 116 (17%), three out of 114 (2.6%) and 33 out of 286 (11.5%) cases with NCA, RTCI and c-ROSE, respectively. Application of statistical analysis revealed significant difference in the NDS between the groups of cases in the operating room with NCA and RTCI (P =.005). The different settings and variables between the cases performed using RTCI in the operating room and those assisted with c-ROSE in the bronchoscopy suite preclude legitimate comparison. Conclusion: Our results indicate that the use of RTCI could yield a significantly low proportion of NDS when assisting EBUS-TBNA of mediastinal and hilar lymph node for lung cancer patients enhancing the diagnostic efficiency of the procedure.

Original languageEnglish (US)
Pages (from-to)318-325
Number of pages8
JournalCytopathology
Volume32
Issue number3
DOIs
StatePublished - May 2021
Externally publishedYes

Keywords

  • EBUS-TBNA
  • ROSE
  • lung cancer staging
  • mediastinal lymph node
  • pulmonary cytopathology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

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