title: Endobronchial Ultrasound-Transbronchial Needle Aspiration for Lymphoma in Patients With Low Suspicion for Lung Cancer and Mediastinal Lymphadenopathy.
abstract: BACKGROUND
  Although the role for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for metastatic lung cancer is well described, the usefulness of EBUS-TBNA for diagnosing lymphoma is less well defined. We aimed to determine the diagnostic accuracy for lymphoma of EBUS-TBNA with rapid, on-site evaluation in the evaluation of mediastinal lymphadenopathy in patients with a low-suspicion for lung cancer.
  
  
  METHODS
  Medical records for all EBUS-TBNA (381 total procedures) from 2007 to 2013 were reviewed, and procedure indication, prior workup, cytologic diagnosis, histologic follow-up, and available ancillary studies were abstracted. Intraoperative rapid on-site evaluation was performed for 170 of 173 patients (98%), and evaluations for 133 (78%) were adequate for diagnosis.
  
  
  RESULTS
  Of 381 patients, 173 (45.4%) underwent mediastinal tissue sampling to evaluate indeterminate mediastinal lymphadenopathy; 208 patients with known or suspected lung cancer were excluded. EBUS-TBNA provided a definitive diagnosis (predominantly carcinoma and granulomatous inflammation) in 71%. EBUS-TBNA was diagnostic in 8 of 16 patients (50%) where the final diagnosis of lymphoma in 16 was confirmed (9 non-Hodgkin, 6 Hodgkin, and 1 posttransplant lymphoproliferative disorder). EBUS-TBNA was indeterminate in 3 (19%), inadequate in 4 (25%), and falsely negative in 1 (6%). Histologic follow-up was available in 10 patients (63%). When the specimen was adequate for diagnosis, sensitivity for lymphoma was 89%.
  
  
  CONCLUSIONS
  EBUS-TBNA has high sensitivity and a low false-negative rate for lymphoproliferative disorders when specimens are adequate for analysis and provides alternative diagnoses in most cases, thus reducing the need for mediastinoscopy. Rapid, on-site evaluation was nondiagnostic in approximately 25% of patients; performing EBUS-TBNA in the operating room facilitated conversion to mediastinoscopy and definitive diagnosis in this setting.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: nasonks@upmc.edu.
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Amy
authors.initials: A
authors.lastname: Kirchner
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Liron
authors.initials: L
authors.lastname: Pantanowitz
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Arivarasan
authors.initials: A
authors.lastname: Karunamurthy
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Monaco
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007430:Intraoperative Care; D000072281:Lymphadenopathy / Q000209:etiology / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008481:Mediastinoscopy; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019564:Unnecessary Procedures