title: Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis and Subtyping of Lymphoma.
abstract: BACKGROUND
  Excisional biopsies are typically used to diagnose lymphoma, but data suggest that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is equally effective. In this study, we determined whether EBUS-TBNA could accurately diagnose and subtype lymphoma.
  
  
  METHODS
  The cases of patients who had undergone EBUS-TBNA for suspected lymphoma were retrospectively reviewed. EBUS-TBNA results were categorized as lymphoma, specific nonlymphoma diagnosis, granulomatous inflammation, or adequate or inadequate lymphocytes with no specific diagnosis. To quantify the ability of EBUS-TBNA to diagnose lymphoma, we used likelihood ratios. To quantify the ability of EBUS-TBNA to diagnose and subtype lymphoma, we calculated sensitivity and specificity. For this analysis, lymphoma that could be subtyped on the basis of EBUS-TBNA was classified as a true positive; lymphoma that could not be subtyped was classified as a false negative.
  
  
  RESULTS
  Of the 181 patients included, 75 (41.5%) were ultimately diagnosed with lymphoma. EBUS-TBNA was able to establish a diagnosis of lymphoma in 63 patients (84%). Granulomatous inflammation diagnosed on the basis of EBUS-TBNA was associated with a low likelihood of lymphoma being present (likelihood ratio, 0.00; 95% confidence interval [CI], 0.00-0.276). Adequate lymphocytes were associated with a low likelihood of lymphoma (LR, 0.25; 95% CI, 0.14-0.49). EBUS-TBNA was able to establish a diagnosis and subtype the lymphoma in 67% (95% CI, 0.45-0.88) of patients with de novo lymphoma and 81% (95% CI, 0.70-0.91) of patients with relapsed lymphoma.
  
  
  CONCLUSIONS
  EBUS-TBNA is an effective, minimally invasive diagnostic test for patients with suspected lymphoma and can provide valuable clinical information, even with "negative" results.
authors.affiliation: 1 Department of Pulmonary Medicine.
authors.forename: Horiana B
authors.initials: HB
authors.lastname: Grosu
authors.affiliation: 2 Department of Pulmonary Medicine, The University of Texas Health Science Center, Houston, Texas; and.
authors.forename: Mihai
authors.initials: M
authors.lastname: Iliesiu
authors.affiliation: 3 Department of Pathology.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Caraway
authors.affiliation: 4 Department of Hematopathology, and.
authors.forename: L Jeffrey
authors.initials: LJ
authors.lastname: Medeiros
authors.affiliation: 5 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.affiliation: 1 Department of Pulmonary Medicine.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.affiliation: 1 Department of Pulmonary Medicine.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.affiliation: 6 Department of Pulmonary Medicine, Michael DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Casal
authors.affiliation: 1 Department of Pulmonary Medicine.
authors.forename: David
authors.initials: D
authors.lastname: Ost
authors.affiliation: 1 Department of Pulmonary Medicine.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008223:Lymphoma / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: endobronchial ultrasound–guided fine needle aspiration; lymphoma; mediastinal lymphadenopathy