Endobronchial Needle Aspiration in the Diagnosis of Small-Cell Carcinoma: Methods


Endobronchial Needle Aspiration in the Diagnosis of Small-Cell Carcinoma: MethodsSince its introduction by Wang et al in the early 1980s, transbronchial needle aspiration (TBNA) via the fiberoptic bronchoscope has become a valuable adjunct in the evaluation of patients with lung cancer. The utility of TBNA in assessing mediastinal adenopathy and in staging lung cancer has been well documented.” Additionally, TBNA has been shown to increase diagnostic yield in patients with submucosal or peribronchial tumors, and it can be used to sample peripheral masses with the help of fluoroscopy.” By contrast, the role of endobronchial needle aspiration (EBNA) in the diagnosis of endobronchial masses is less well defined; forceps biopsy remains the preferred method of pathologic evaluation of these lesions. Buy inhalers online Source It has been suggested that needle aspiration of endobronchial masses is useful primarily in avoiding bleeding from friable lesions. However, we have recently noted several instances in which EBNA of exophytic masses played a definitive role in establishing a diagnosis of small-cell carcinoma. We describe five patients who had obstructing endobronchial masses in whom forceps biopsy specimens were nondiagnostic due to crush artifact (four cases) or sampling error (one case). In three cases, all other cytologic specimens were nondiagnostic; in one, a transtracheal needle aspirate was also positive; and in a fifth case, a concurrent bronchial wash of borderline adequacy was interpreted as positive after comparison with the EBNA material.
A review of a computerized list of specimens obtained bronchoscopically and sent to our pathology department for interpretation from the last 4 years was performed. All bronchoscopies were performed by or under the direct supervision of an attending pulmonologist. The diagnostic procedures performed during the bronchoscopy were at the discretion of the operator based on endobronchial findings, patient tolerance, and preoperative clinical suspicions. All EBNA specimens were obtained through a fiberoptic bronchoscope using standard 22-gauge, 13-mm-long transbronchial cytology needles (Mill-Rose, Mentor, Ohio). Cases were identified in which EBNA material obtained from endobronchial masses was positive for small-cell carcinoma but the concurrent biopsy specimens were not definitive. These cases were then reviewed for pathologic accuracy (J.O.C.).