Usefulness of conventional transbronchial needle aspiration in the diagnosis, staging and molecular characterization of pulmonary neoplasias by thin-prep based cytology: experience of a single oncological institute.
BACKGROUND
Conventional transbronchial needle aspiration (c-TBNA) contributed to improve the bronchoscopic examination, allowing to sample lesions located even outside the tracheo-bronchial tree and in the hilo-mediastinal district, both for diagnostic and staging purposes.


METHODS
We have evaluated the sensitivity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the c-TBNA performed during the 2005-2015 period for suspicious lung neoplasia and/or hilar and mediastinal lymphadenopathy at the Thoracic endoscopy of the Thoracic Surgery Department of the Regina Elena National Cancer Institute, Rome. Data from 273 consecutive patients (205 males and 68 females) were analyzed.


RESULTS
Among 158 (58%) adequate specimens, 112 (41%) were neoplastic or contained atypical cells, 46 (17%) were negative or not diagnostic. We considered in the analysis first the overall period; then we compared the findings of the first [2005-2011] and second period [2012-2015] and, finally, only those of adequate specimens. During the overall period, sensibility and accuracy values were respectively of 53% and 63%, in the first period they reached 41% and 53% respectively; in the second period sensibility and accuracy reached 60% and 68%. Considering only the adequate specimens, sensibility and accuracy during the overall period were respectively of 80% and 82%; the values obtained for the first period were 68% and 72%. Finally, in the second period, sensibility reached 86% and accuracy 89%. Carcinoma-subtyping was possible in 112 cases, adenocarcinomas being diagnosed in 50 cases; further, in 30 cases molecular predictive data could be obtained.


CONCLUSIONS
The c-TBNA proved to be an efficient method for the diagnosis/staging of lung neoplasms and for the diagnosis of mediastinal lymphadenopathy. Endoscopist's skill and technical development, associated to thin-prep cytology and to a rapid on site examination (ROSE), were able to provide by c-TBNA a high diagnostic yield and molecular predictive data in advanced lung carcinomas.
Department of Pathology, "F. Spaziani" Hospital, ASL Frosinone, Italy ;
Maria Teresa
MT
Ramieri
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Ferdinando
F
Marandino
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Paolo
P
Visca
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Tommaso
T
Salvitti
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Enzo
E
Gallo
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Beatrice
B
Casini
Anaesthesia and Intensive Care Complex Unit, Regina Elena National Cancer Institute, Rome, Italy.
Francesca Romana
FR
Giordano
Anaesthesia and Intensive Care Complex Unit, Regina Elena National Cancer Institute, Rome, Italy.
Claudia
C
Frigieri
Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy.
Mauro
M
Caterino
Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy.
Sandro
S
Carlini
Medical Oncology "B" Department, Regina Elena National Cancer Institute, Rome, Italy.
Massimo
M
Rinaldi
Medical Oncology "A" Department, Regina Elena National Cancer Institute, Rome, Italy.
Anna
A
Ceribelli
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Annarita
A
Pennetti
Department of Pathology, "F. Spaziani" Hospital, ASL Frosinone, Italy ;
Pier Luigi
PL
Alò
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Mirella
M
Marino
Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
Edoardo
E
Pescarmona
Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy.
Massimo
M
Filippetti
Transbronchial needle aspiration (TBNA); conventional TBNA (c-TBNA); lung cancer; molecular diagnostics; rapid on site examination (ROSE)