Endobronchial Needle Aspiration in the Diagnosis of Small-Cell Carcinoma: Discussion
A 77-year-old man presented with a history of increasing dyspnea, malaise, weight loss, and dry cough over the preceding months. Chest radiograph and computed tomography demonstrated a large peripheral right lower lobe mass with hilar and mediastinal adenopathy. Bronchoscopy revealed extensive submucosal involvement of the right middle and lower lobe bronchus with tumor nodules protruding through the mucosa. Bronchial washings, brushings, and transcarinal needle aspirate were negative for tumor. The forceps biopsy specimen showed crush artifact. A diagnosis of small-cell carcinoma, intermediate variant, was rendered on the EBNA specimen.
Forceps biopsy is generally considered to be the method of choice in the diagnosis of exophytic endobronchial tumors because it offers the advantages of a high diagnostic yield and results in procurement of a histologic, rather than a cytologic, specimen. The yield exceeds 90 percent and approaches 100 percent when multiple biopsy specimens are obtained.’ Several studies have shown that in the evaluation of visible endobronchial tumors, forceps biopsies result in an equivalent or higher diagnostic yield than EBNA review canadian neighbor pharmacy. Buirski et al studied 60 consecutive patients with proximal endobronchial tumors and reported the diagnostic yield from endobronchial forceps biopsies to be 67 percent compared with 80 percent for needle aspirates. This difference was not statistically significant. Lundgren et al found that in individuals with visible tumors, the yield of needle aspiration was 65 percent, while that of forceps biopsies was 85 percent. Conversely, Shure and Fedullo studied 31 patients with endoscopic abnormalities suggestive of submucosal or peribronchial tumor (without frank endobronchial lesions) and found that needle aspiration significantly increased the yield over forceps biopsy alone. Pearse and Wang investigated the utility of endobronchial needle aspiration using an 18-gauge needle and noted that, compared with forceps biopsy, there was less bleeding and crush artifact. Therefore, the use of EBNA in the evaluation of exophytic endobronchial lesions has been relegated mainly to friable or bleeding lesions and, in particular, to endobronchial carcinoid tumors. However, we report five cases that suggest that EBNA may serve as an important adjunct in the diagnosis of endobronchial small-cell carcinoma.