The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience

Aim To assess the diagnostic role of endobronchial ultrasound (EBUS) guided transbronchial fine needle aspiration (TBNA) cytology, in the investigation of mediastinal lymphadenopathy and masses, with emphasis on pathology, criteria for adequacy, and use of liquid based cytology (LBC). Methods In January 2008, EBUS guided TBNA was introduced for the staging of lung cancers and for the investigation of unexplained mediastinal lymphadenopathy and masses. Initially, the material was processed conventionally. In May 2008, the laboratory procured the Cytyc T2000. Results 250 specimens (229 patients) were included from January 2008 to August 2009. The overall inadequate rate was 12%; 16.6% with the conventional method, 17.2% when both conventional and LBC were used, and 9.8% with LBC. With the conventional method, an average of 7.5 slides and one cell block were received per case. With LBC, one slide and one cell block were used for diagnosis. In 72 cases (28.8%) the aspirate showed no evidence of malignancy. In 122 cases (48.8%), there was metastatic disease. In five cases (2%), a diagnosis of atypia, suspicious for non-small cell malignancy, was made. One case (0.4%) each of amyloidosis and mediastinal goitre, 3 cases (1.2%) of lymphoma, 14 cases (5.6%) of sarcoidosis and 1 case (0.4%) each of sarcoma and mesothelioma were seen. Conclusions EBUS guided TBNA, in our experience, is a reliable technique for staging of lung cancers, and investigation of unexplained mediastinal lymphadenopathy and masses. LBC reduces the number of slides from 7.5 per case to 1 slide, reducing time required for diagnosis.