title: Transbronchial fine needle aspiration biopsy and rapid on-site evaluation in the setting of superior vena cava syndrome.
abstract: There is a paucity of prospective data on flexible bronchoscopy with rapid on-site evaluation (ROSE) in the setting of superior vena cava (SVC) syndrome. The aims of this prospective study were to assess the diagnostic yield and safety of these investigations and specifically to evaluate the role of ROSE in limiting the need for tissue biopsies. Over a 5-year period 48 patients (57.4 ± 9.7 years) with SVC syndrome secondary to intrathoracic tumors underwent flexible bronchoscopy with TBNA and ROSE. Endobronchial Forceps biopsy was reserved for visible endobronchial tumors with no on-site confirmation of diagnostic material. ROSE confirmed diagnostic material in 41 cases (85.4%), and in only one of the remaining cases did the addition of a forceps biopsy increase the diagnostic yield (overall diagnostic yield of 87.5%). No serious complications were noted. The final diagnoses made included nonsmall lung cancer (n = 27), small cell lung cancer (n = 16), and metastatic carcinoma (n = 3). Two undiagnosed cases died of suspected advanced neoplasms (unknown primary tumors). We conclude that TBNA has a high diagnostic yield and is safe in the setting of SVC syndrome. With the addition of ROSE, tissue biopsy is required in the minority of cases.
authors.affiliation: Division of Anatomical Pathology, Department of Pathology, University of Stellenbosch and National Health Laboratory Services, Cape Town, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Brundyn
authors.forename: C F N
authors.initials: CF
authors.lastname: Koegelenberg
authors.forename: A H
authors.initials: AH
authors.lastname: Diacon
authors.forename: M
authors.initials: M
authors.lastname: Louw
authors.forename: P
authors.initials: P
authors.lastname: Schubert
authors.forename: C T
authors.initials: CT
authors.lastname: Bolliger
authors.forename: M M
authors.initials: MM
authors.lastname: van den Heuvel
authors.forename: C A
authors.initials: CA
authors.lastname: Wright
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D001999:Bronchoscopy / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis*; D002467:Cell Nucleus; D053144:Cell Nucleus Shape; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis*; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis*