title: The diagnostic efficacy of combining bronchoscopic tissue biopsy and endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of malignant lesions in the lung.
abstract: Bronchoscopic tissue forceps biopsy (BBX) is a standard procedure for diagnosis of malignancy in the lung. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has proven to be a sensitive alternative to tissue biopsy for the diagnosis and staging of lung tumors. We report our institutional experience with diagnostic yield when combining BBX and EBUS-TBNA in the bronchoscopic evaluation of patients presenting with lung lesion(s). The pathology files at our institution were searched for all patients who underwent combined BBX and EBUS-TBNA procedures between 1/09 and 6/10 for the diagnosis of malignancy. The data points included biopsy site, cytologic, and histopathologic diagnoses and follow-up. We identified 115 patients who underwent BBX combined with EBUS-TBNA. About 107 (93%) of the patients received a definitive pathologic diagnosis; 93 (81%) were malignant. BBX and EBUS-TBNA of the lung lesion only were performed in 21 patients, BBX and EBUS-TBNA of lymph node(s) only in 78 patients with BBX and a combination of EBUS-TBNA of the lung lesion and lymph node(s) in 16 patients. Immunostains were performed for 71 (76%) patients and molecular testing for 11 (12%) patients. Diagnostic yield is increased when bronchoscopic technologies are combined. In a significant number of patients where BBX was negative, EBUS-TBNA provided diagnostic material, increasing diagnostic yield by 18%. In a subset of these patients the EBUS-TBNA assisted in the staging of a primary tumor. By combining these procedures, more tissue was obtained for immunohistochemistry and molecular testing, which facilitated personalized management in a minimally invasive manner.
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lauren Ende
authors.initials: LE
authors.lastname: Schwartz
authors.forename: Dara L
authors.initials: DL
authors.lastname: Aisner
authors.forename: Zubair W
authors.initials: ZW
authors.lastname: Baloch
authors.forename: Daniel
authors.initials: D
authors.lastname: Sterman
authors.forename: Anil
authors.initials: A
authors.lastname: Vachani
authors.forename: Colin
authors.initials: C
authors.lastname: Gillespie
authors.forename: Andrew
authors.initials: A
authors.lastname: Haas
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Litzky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000556:secondary; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged