title: Evaluation of endobronchial ultrasound-guided fine-needle aspirations (EBUS-FNA): correlation with adequacy and histologic follow-up.
abstract: BACKGROUND
  Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) is a minimally invasive modality for diagnosing mediastinal lesions. When determining adequacy, EBUS-FNAs are evaluated for diagnostic material or sufficient lymphoid tissue. In this study, the authors evaluated their experience with EBUS-FNAs and correlated the findings with adequacy and histologic follow-up.
  
  
  METHODS
  EBUS-FNAs were retrospectively reviewed over a 3-year period and correlated with the clinicopathologic findings, adequacy, and histologic follow-up.
  
  
  RESULTS
  In total, 593 EBUS-FNAs were obtained from 356 patients, including 420 (71%) satisfactory (SAT) cases, 107 (18%) less than optimal (LTO) cases, and 66 (11%) unsatisfactory (UNSAT) cases. The overall diagnostic yield was 71%, and the mediastinal (N2) lymph nodes had better yield (72%) than the peripheral intrapulmonary and hilar (N1) lymph nodes (64%). Histologic follow-up was available in 203 cases (34%), and malignancy was identified in 7 UNSAT cases (23%), 6 LTO-negative cases (11%), and 4 SAT cases (3%) with a negative cytologic diagnosis. In the suboptimal cases with follow-up, 79% were benign and 21% were malignant on follow-up, including 25 (14%) with fibrosis or hyalinization. The sensitivity, specificity, and positive and negative predictive values in the study were 80%, 100%, 100%, and 95%, respectively.
  
  
  CONCLUSIONS
  The current data demonstrated that EBUS-FNA has good sensitivity, high specificity, and a higher diagnostic yield for N2 lymph nodes compared with N1 lymph nodes. The data also illustrate the finding that suboptimal cases have a greater risk of false-negative diagnoses and a 21% chance of malignancy, including processes with fibrosis or hyalinization.
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Arivarasan
authors.initials: A
authors.lastname: Karunamurthy
authors.forename: Guoping
authors.initials: G
authors.lastname: Cai
authors.forename: Sanja
authors.initials: S
authors.lastname: Dacic
authors.forename: Walid E
authors.initials: WE
authors.lastname: Khalbuss
authors.forename: Liron
authors.initials: L
authors.lastname: Pantanowitz
authors.forename: Sara E
authors.initials: SE
authors.lastname: Monaco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D016208:Databases, Factual; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: EBUS; cytopathology; endobronchial; endobronchial ultrasound; fine needle aspiration