Correlating Ultrasonographic Features of Lymph Nodes During Endobronchial Ultrasound With Final Outcome.

Background In clinical practice, metastatic primary lung cancer, TB, and sarcoidosis are the commonest causes of mediastinal lymphadenopathy. Differentiation of malignant from benign causes is essential. The sonographic features seem to correlate with malignancy in head and neck, breast, and cervix cancers and can be used to predict the etiology of lesions. The objective of our study was to assess the utility of different ultrasonographic features in differentiating benign and malignant lymph nodes by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Methods This is a prospective study analysis of all patients above 18 years presenting with mediastinal and hilar adenopathy on computed chest tomography with contrast, undergoing EBUS-TBNA for diagnosis. Lymph node ultrasonographic characteristics such as size, shape, echogenicity, margins, central hilar structure (CHS), and coagulation necrosis sign (CNS) were recorded and compared with histopathology. Results A total of 576 patients underwent the EBUS-TBNA procedure, and a total of 810 lymph nodes were evaluated. Three hundred and forty-eight patients (468 lymph nodes) were malignant; 228 patients (342 lymph nodes) were benign. Heterogeneous echotexture was significantly higher in malignant lymph nodes (<0.001). The multivariate analysis revealed that heterogeneous echotexture was an independent predictor for malignant etiology. Conclusion Heterogeneous echotexture of the lymph node on EBUS was predictive of malignancy. If heterogenicity is observed on EBUS, subsequent sampling of that lymph node might be considered, which may yield a higher diagnostic yield and may reduce the number of lymph nodes requiring sampling and further invasive procedures.

"To do or not to do - that is the question". Transvascular needle aspiration during EBUS (EBUS-TVNA) with review of the literature.

INTRODUCTION: Large vessels are often encountered during endobronchial ultrasound (EBUS). Safety of traversing the vessels weighed against a more invasive procedure can be a dilemma. MATERIAL AND METHODS: We describe a case series of 8 patients who underwent transvascular needle aspiration during EBUS, to access a lesion in the absence of an alternate safe window. A 21 gauge EBUS needle was used to traverse either the main or a major branch of the pulmonary artery. RESULTS: Malignancy was suspected at ROSE in five cases. Granuloma and necrosis noted in 2 cases were confirmed as tubercu-losis on culture. Diagnostic yield of EBUS-TVNA was 87.5% (7/8). No complications were noted in the immediate post-operative period as well as during 6 months of follow up. CONCLUSION: EBUS-TVNA in carefully selected patients is a feasible alternative to more invasive procedures with excellent yield. Appropriate intraoperative, perioperative and postoperative monitoring and care must be available in the case of fatal bleeds.

EGFR analysis on scrapings from cytology smears in lung carcinoma, an effective alternative to testing on trucut biopsies.

BACKGROUND: Lung carcinomas are a leading cause of cancer morbidity and mortality. Many cases present at an advanced stage of disease where definitive treatment by surgical resection is not feasible. Molecular testing using materials derived from minimally invasive procedures aid in targeted therapy with least iatrogenic burden to the patient. METHODS: Cases diagnosed as non-small cell lung carcinoma (NSCLC) on cytology were included in the study. Scrapings from the smears with adequate tumor cell load were submitted for molecular testing. The DNA was extracted and quantified. Mutations in exons 18, 19, 20, and 21 of the EGFR gene were detected using Sanger sequencing. DNA quantity and EGFR mutation status on equal number of consecutive trucut biopsy specimens were also analyzed. RESULTS: Seventy cases of NSCLC tested for EGFR mutation had a median DNA concentration of 40.2 ng/µl and 31% cases showed mutation. Majority of mutations (14/21, 66.66%) were identified in exon 19. Among 70 trucut biopsy samples, DNA concentration was 41.42 ng/µl and 30% cases showed mutation. No significant difference was seen in DNA quantity and EGFR mutation between cytology smears and trucut biopsies. CONCLUSION: EGFR testing on cytology smears provides adequate DNA yield with minimal invasiveness and is equally effective as biopsies. Testing on samples like pleural effusion allows for concomitant diagnosis, staging, and molecular testing in one procedure. Tests done on the smears rather than on cell block or trucut biopsies ensures superior quality DNA from the tumor cells as they are unexposed to cross linking formalin fixative.