JTO Clinical and Research Reports (Oct 2022)

Prospective Optimization of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Lymph Node Assessment for Lung Cancer: Three Needle Agitations Are Noninferior to 10 Agitations for Adequate Tumor Cell and DNA Yield

  • David Fielding, FRACP, MD,
  • Andrew J. Dalley, PhD,
  • Mahendra Singh, FRCPA,
  • Lakshmy Nandakumar, FRCPA,
  • Katia Nones, PhD,
  • Vanessa Lakis, MBioinf,
  • Haarika Chittoory, MBiotech,
  • Kaltin Ferguson,
  • Farzad Bashirzadeh, FRACP,
  • Michael Bint, FRACP,
  • Carl Pahoff, FRACP,
  • Jung Hwa Son, RN,
  • Alan Hodgson, CT ASC,
  • Sowmya Sharma, FRCPA,
  • David Godbolt, FRCPA,
  • Kylie Coleman, CT ASC,
  • Lenore Whitfield, CT ASC,
  • Nicola Waddell, PhD,
  • Sunil R. Lakhani, FRCPA,
  • Gunter Hartel, PhD,
  • Peter T. Simpson, PhD

Journal volume & issue
Vol. 3, no. 10
p. 100403

Abstract

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) is an important means of obtaining a tissue for advanced lung cancer. Optimizing the EBUS TBNA needling technique is important to maintain procedural simplicity and maximize sample quality for emerging molecular diagnostics. Methods: We prospectively explored three versus 10 agitations of the needle in sequential passes into the lymph node using separate needles. Resulting Diff-Quik cytology smears were quantitatively assessed using microscopic (tumor cell cellularity, abundance scores, erythrocyte contamination) and DNA yields. Microscopy was reported by two cytopathologists, and an inter-rater assessment was made by four additional cytopathologists. Results: In 86 patients confirmed as having malignant disease by EBUS TBNA (45 males, 41 females), a mean of 5.3 smears were made per patient with a total of 459 smears scored by pathologists and 168 paired smears extracted for DNA. There was no significant difference between three versus 10 agitations for smear cellularity (p = 0.44), DNA yield (p = 0.84), or DNA integrity (p = 0.20), but there was significantly less contamination by erythrocytes from three agitations (chi-square p = 0.008). There was significantly more DNA in the first pass into the node using three agitations than with other passes and with 10 agitations (pass × agitations interaction, p = 0.031). Reviewing pathologists correctly classified smears as more than or equal to 25% cellularity 86.3% of the time (κ = 0.63 [95% confidence interval: 0.55–0.71]). Conclusions: Three agitations are noninferior to 10 agitations for overall abundance of malignant cells and DNA content on smears. A smear with adequate DNA for panel sequencing could almost always be made with the first needle pass using three agitations.

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