Eficacia del ultrasonido endobronquial con aspiración por aguja fina en el diagnóstico de lesiones hiliares y mediastinales / Efficacy of endobronchial ultrasound with fine needle aspiration in the diagnosis of hilar and mediastinal lesions

RESUMEN Introducción: El ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina es una técnica novedosa para el diagnóstico de tumores y ganglios mediastínicos e hiliares. Objetivo: Evaluar la eficacia diagnóstica de ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina como método de estudio de lesiones hiliares y mediastinales. Métodos: Se realizó un estudio descriptivo con carácter prospectivo en 49 pacientes a los que se le realizó ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina. Resultados: El diagnóstico se obtuvo mediante la histología y resultaron positivos 48 pacientes, de ellos 45 fueron positivos por el ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina y 4 negativos por este estudio. El resultado global de la investigación mostró una sensibilidad de 93,8 %, especificidad 100 %, valor predictivo positivo de 100 % y predictivo negativo 25 %. De esta manera, el índice de validez de ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina fue de 93,8 %. El número de complicaciones fue mínimo. Conclusiones: El ultrasonido endobronquial lineal con aspiración transbronquial por aguja fina constituye un método diagnóstico eficaz y seguro en el estudio de pacientes que presentan lesiones hiliares y mediastinales con alta sospecha de cáncer de pulmón y a su vez, una alternativa de acceder al mediastino de manera no cruenta para la estadificación ganglionar.

ABSTRACT Introduction: Linear endobronchial ultrasound with transbronchial fine needle aspiration is a novel technique for the diagnosis of tumors and mediastinal and hilar lymph nodes. Objective: To evaluate the diagnostic efficacy of linear endobronchial ultrasound with transbronchial fine needle aspiration as a method of studying hila and mediastinal lesions. Methods: A prospective descriptive study was carried out in 49 patients who underwent linear endobronchial ultrasound with transbronchial fine needle aspiration. Results: The diagnosis was obtained by histology and 48 patients were positive, 45 of them resulted positive by linear endobronchial ultrasound with transbronchial fine needle aspiration and 4 resulted negative by this study. The overall result of the investigation showed a sensitivity of 93.8%, specificity 100%, a positive predictive value of 100% and a negative predictive value of 25%. Thus, the validity index of linear endobronchial ultrasound with transbronchial fine needle aspiration was 93.8%. The number of complications was minimal. Conclusions: Linear endobronchial ultrasound with transbronchial fine needle aspiration is an effective and safe diagnostic method in the study of patients with hilar and mediastinal lesions with high suspicion of lung cancer and, consecutively, it is an alternative to access the mediastinum in a non- invasive approach for lymph node staging.

Utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with rapid on-site evaluation (ROSE) for the molecular classification of progressive breast cancer / Utilidad de la aspiración transbronquial con aguja guiada por ultrasonido endobronquial con evaluación rápida in situ para la clasificación de cáncer de mama progresivo

Abstract Evidence of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in extrathoracic malignancy is limited but emergent. The technique plays a vital role in the diagnosis of mediastinal lesions, staging, and restaging of lung cancer. Its usefulness for the evaluation and molecular classification of progressive breast cancer is described in 7 patients. Stations 7, 11L, and 11R were punctured. Cellblocks, immunohistochemistry and digital analysis were developed in 100% of the cases for molecular classification. This procedure requires multidisciplinary evaluation, image analysis, and evaluation of the general condition of the patient, as well as the risks and benefits. Additionally, it is essential teamwork with a pathology group that performs the rapid on-site evaluation (ROSE), in order to ensure the quality of the samples and molecular characterization.

Resumen Evidencia de la aspiración transbronquial con aguja guiada por ultrasonido endobronquial en malignidad extratorácica es limitada pero emergente. Esta técnica desempeña un papel vital en el diagnóstico de lesiones mediastinales, estadificación y reestadificación del cáncer pulmonar. Se describe su utilidad para la evaluación y la clasificación molecular del cáncer de mama en progresión de siete pacientes. Se puncionaron las estaciones (ganglionares) 7, 11L y 11R. Se desarrollaron bloques celulares, inmunohistoquímica y análisis digital en el 100% de los casos para clasificación molecular. Este procedimiento requiere una evaluación multidisciplinaria, análisis de imágenes y la evaluación del estado general de la paciente, lo mismo que los riesgos y los beneficios. Adicionalmente, es esencial el trabajo conjunto con un grupo de patología que realice la evaluación rápida en sala (ROSE), para así asegurar la calidad de las muestras y la caracterización molecular.

The contribution of cell blocks in the diagnosis of mediastinal masses and hilar adenopathy samples from echobronchoscopy.

BACKGROUND: Cell block material from puncture can be obtained with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in many cases. The aim of this study was to analyse the value of additional information from cell blocks obtained with EBUS-TBNA samples from mediastinal and hilar lymph nodes and masses. METHODS: Review of pathology reports with a specific diagnosis obtained from EBUS-TBNA samples of mediastinal or hilar lesions, prospectively obtained over a two-year period. The generation of cell blocks from cytology needle samples, the contribution to morphological diagnosis, and the possible use of samples for immunohistochemistry were analysed. RESULTS: One hundred and twenty-nine samples corresponding to 110 patients were reviewed. The diagnosis was lung cancer in 81% of cases, extrapulmonary carcinoma in 10%, sarcoidosis in 4%, lymphoma in 2.7%, and tuberculosis in 0.9%. Cell blocks could be obtained in 72% of cases. Immunohistochemistry studies on the cell blocks were significantly easier to perform than on conventional smears (52.6% vs. 14%, P<.0001). In 4cases, the cell block provided an exclusive morphological diagnosis (3sarcoidosis and one metastasis from prostatic carcinoma) and in 3carcinomas, subtype and origin could be identified. Exclusive diagnoses from the cell block were significantly more frequent in benign disease than in malignant disease (25% vs 0.9%, P=.002). CONCLUSIONS: Cell blocks were obtained from 72% of EBUS-TBNA diagnostic procedures. The main contributions of cell blocks to pathology examinations were the possibility of carrying out immunohistochemical staining for the better classification of neoplasms, especially extrapulmonary metastatic tumours, and the improved diagnosis of benign lesions.