Cytologic accuracy of samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration at Thomas Jefferson University Hospital.

OBJECTIVE: To evaluate the diagnostic yield and cytologic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in cases of clinically suspected epithelial malignancy, sarcoidosis and lymphoma. STUDY DESIGN: Over a 9-month period from inception at Thomas Jefferson University Hospital, a retrospective analysis of the cytologic diagnoses of all EBUS-TBNA procedures performed in 48 patients was undertaken. The patients were divided into 2 groups, those with clinical suspicion of an epithelial malignancy and those with clinical suspicion of sarcoidosis or lymphoma. RESULTS: Of the 48 patients who underwent EBUS-TBNA, 39 had adequate fine needle aspiration biopsy samples (60 of 78) with a diagnostic yield of 77%; the pre-EBUS yield was 58%. For the group with malignant disease the calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were all 100%. For the group with benign disease the calculated sensitivity, specificity, PPV and NPV were also 100%. CONCLUSION: Preliminary results show that cytologic samples obtained via BUS-TBNA are accurate and specific in making a diagnosis of an epithelial malignancy or benign disease.

Paranasal sinus melanoma masquerading as chronic sinusitis and nasal polyposis.

Malignant melanoma of the nose and paranasal sinuses can be a devastating disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. It is an uncommon process, often misdiagnosed both clinically and pathologically. We present the case of an 80-year-old man who had a 2-month history of progressively worsening left-sided epistaxis and nasal obstruction. Radiographic evidence indicated the presence of soft tissue in the left maxillary sinus and nasal cavity resembling massive nasal polyposis and chronic fungal sinusitis. Magnetic resonance imaging was not performed because the patient had a pacemaker. After endoscopic debridement of the soft-tissue mass, frozen-section analysis detected no evidence of tumor. The final pathologic diagnosis was malignant melanoma. Otolaryngologists should be familiar with the difficulties inherent in the diagnosis and management of sinonasal melanomas.