title: Efficient utilization of EBUS-TBNA samples for both diagnosis and molecular analyses.
abstract: BACKGROUND
  The assessment of an increasing number of molecular markers is becoming a standard requirement from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimens. However, it is unclear how many needle passes should be performed and the amount of lung cancer cells that should be sent for molecular analyses. The objective of this study was to determine if it is feasible to divide the material obtained by EBUS-TBNA to allow for molecular analysis without compromising the accuracy of mediastinal staging.
  
  
  OBJECTIVE
  We aimed to determine if dividing EBUS-TBNA specimens has a negative impact on either histopathological diagnosis or molecular analysis.
  
  
  METHODS
  EBUS-TBNA was performed in 249 enlarged lymph nodes. Negative or ambiguous histopathological results were confirmed by surgical means and clinical follow-up over 6 months. The tissue obtained by EBUS-TBNA was placed onto a glass slide and divided for histopathological workup and molecular analysis. The number of passes was recorded. Both the accuracy of the mediastinal lymph node staging and the applicability of the sample division for molecular analysis were assessed.
  
  
  RESULTS
  Each lymph node was punctured an average of 3.18 times and division of the obtained material for diagnosis and molecular analysis was feasible in all cases. The sensitivity and accuracy of the mediastinal lymph node staging were 96.6% and 97.6%, respectively. A cytokeratin (CK)-19-mRNA concentration-based molecular test was feasible in 74.1% of cases.
  
  
  CONCLUSIONS
  Dividing EBUS-TBNA samples for both histopathological diagnosis and molecular testing is feasible and does not compromise the accuracy of mediastinal staging. This method may be an alternative to taking additional needle passes for molecular analyses.
authors.affiliation: Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Oezkan
authors.affiliation: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Am
authors.initials: A
authors.lastname: Khan
authors.affiliation: Pulmonary Department-Oncology Unit, 'G Papanikolaou' General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Zarogoulidis
authors.affiliation: II Medical Clinic, Coburg Hospital, University of Wuerzburg, Coburg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hohenforst-Schmidt
authors.affiliation: Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Theegarten
authors.affiliation: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Yasufuku
authors.affiliation: Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Freitag
authors.affiliation: Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Darwiche
keywords: CK-19-mRNA; lung cancer; lymph node sampling; molecular marker