Rapid on-site evaluation has been proposed as a method to improve the yield of transbronchial needle aspiration.
This study investigated whether on-site analysis facilitates routine diagnostic ...bronchoscopy in terms of sampling, yield and cost.
Patients with lesions accessible for transbronchial needle aspiration on computed tomography were investigated. A cytopathologist screened the needle aspirates on site for the presence of diagnostic material. The bronchoscopic sampling process was adjusted according to the results. In 90 consecutive patients with neoplastic disease (n=70; 78%), non-neoplastic disease (n=16; 18%) or undiagnosed lesions (n=4; 4%) we aspirated 162 lung tumours or lymph node sites (mediastinal: 7%; tracheobronchial: 68%; other: 25%). In 90 consecutive patients with neoplastic disease (n=70; 78%), non-neoplastic disease (n=16; 18%) or undiagnosed lesions (n=4; 4%) we aspirated 162 lung lesions (paratracheal tumours or lymph nodes: 7%; tracheobronchial lymph nodes: 68%; other: 25%).
The diagnostic yield of needle aspiration was 77 and 25% in patients with neoplastic and non-neoplastic lesions, respectively. Sampling could be terminated in 64% of patients after needle aspiration had been performed as the only diagnostic modality, and on-site analysis identified diagnostic material from the first site aspirated in 50% of patients. Only in 2 patients (2%) diagnostic aspirates were not recognized on site. On-site analysis was cost effective due to savings for disposable diagnostic tools, which exceeded the extra expense for the on-site cytology service provided.
Rapid on-site analysis of transbronchial aspirates is a highly useful, accurate and cost-effective addition to routine diagnostic bronchoscopy.
Tuberculous pleuritis remains the commonest cause of exudative effusions in areas with a high prevalence of tuberculosis and histological and/or microbiological confirmation on pleural tissue is the ...gold standard for its diagnosis. Uncertainty remains regarding the choice of closed pleural biopsy needles.
This prospective study compared ultrasound-assisted Abrams and Tru-Cut needle biopsies with regard to their diagnostic yield for pleural tuberculosis.
89 patients (54 men) of mean ± SD age 38.7 ± 16.7 years with pleural effusions and a clinical suspicion of tuberculosis were enrolled in the study. Transthoracic ultrasound was performed on all patients, who were then randomly assigned to undergo ≥ 4 Abrams needle biopsies followed by ≥ 4 Tru-Cut needle biopsies or vice versa. Medical thoracoscopy was performed on cases with non-diagnostic closed biopsies. Histological and/or microbiological proof of tuberculosis on any pleural specimen was considered the gold standard for pleural tuberculosis.
Pleural tuberculosis was diagnosed in 66 patients, alternative diagnoses were established in 20 patients and 3 remained undiagnosed. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 81 patients (91.0%) and were diagnostic for tuberculosis in 54 patients (sensitivity 81.8%), whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 70 patients (78.7%, p=0.015) and were diagnostic in 43 patients (sensitivity 65.2%, p=0.022).
Ultrasound-assisted pleural biopsies performed with an Abrams needle are more likely to contain pleura and have a significantly higher diagnostic sensitivity for pleural tuberculosis.
Transbronchial Needle Aspirates Diacon, Andreas H.; Schuurmans, Macé M.; Theron, Johan ...
Chest,
June 2005, 20050601, 2005-06-00, Letnik:
127, Številka:
6
Journal Article
Recenzirano
Transbronchial needle aspiration has evolved as a key bronchoscopic sampling method. Specimen handling and preparation are underrated yet crucial aspects of the technique. This study was designed to ...identify which of two widely practiced sample preparation methods has a higher yield.
Prospective comparison of two diagnostic methods.
Tertiary academic hospital.
Consecutive patients undergoing transbronchial needle aspiration.
Transbronchial aspirates were obtained pairwise. One specimen was placed directly onto a slide and smears were prepared on site (ie, the direct technique), and the other specimen was deposited into a vial containing 95% alcohol and further prepared in the laboratory (ie, the fluid technique). In total, 282 pairs of samples were aspirated from 145 target sites (paratracheal, 10 sites; tracheobronchial, 101 sites; hilar, 17 sites; endobronchial or peripheral, 17 sites).
The measured outcome was the presence of diagnostic material at the final laboratory assessment. At least one diagnostic aspirate was obtained in 66% of 86 investigated patients (small cell lung cancer, 18 patients; non-small cell lung cancer, 47 patients; other diagnoses, 21 patients). The direct technique had a better yield overall than the fluid technique (positive aspirates, 36.2% vs 12.4%, respectively; p < 0.01), as well as after stratification for tumor type and for anatomic site.
The direct technique is superior to the fluid technique for the preparation of transbronchial needle aspirates.
Immunochemistry is now an established ancillary technique in lung cancer diagnosis. Not only does it help in supporting the morphological diagnosis of malignancy, but its role now extends to the ...determination of cell lineage, ascertaining the primary site of tumour origin and contributing to decisions on prognosis and treatment. Early detection and confirmation of lung cancer facilitate early treatment decisions. Lung cancer management now has a multidisciplinary approach which includes cytopathologists and clinicians. Some clinicians may not understand what immunochemistry is and what its role is in lung cancer diagnosis, prognosis and therapy. The purpose of this paper is to define immunochemistry, on the background of basic respiratory airway epithelial structure and cancer biology, and discuss its application in the diagnosis, treatment and determination of prognosis of lung cancer.
To apply cytomorphologic features and a limited panel of immunocytochemistry to cervicovaginal smears to distinguish between primary endocervical adenocarcinoma (ECA) and primary endometrial ...adenocarcinoma (EMC).
The study was a retrospective analysis of 35 cases, of which 21 were of primary endometrial origin and 14 were of primary endocervical origin. In all cases included in the study, the site of origin of adenocarcinoma was confirmed by examination of the surgical specimen. Twenty-four cytomorphologic characteristics and a limited panel of antibodies (estrogen receptor, carcinoembryonic antigen and vimentin) were applied to conventional cervicovaginal smears to ascertain whether a combination of these would be sufficiently distinctive to allow reliable distinction between ECA and EMC. The slides were scored using defined cytomorphologic characteristics and immunocytochemistry. The score was calculated by using the receiver operating curve (ROC).
Statistical analysis identified 7 variables that were significant in distinguishing between ECA and EMC: necrosis, altered blood, histiocytes, strips of cells, palisading of cells, pseudorosettes and positive immunocytochemical staining for carcinoembryonic antigen. Using the ROC, a numerical score < 4 was indicative of an EMC and a score > or = 4 of ECA.
This study found that the proposed scoring system based on these 7 variables could reliably distinguish between ECA and EMC and assist in definitive management of patients.
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