Annals of Oncology Research and Therapy (Jan 2023)
Role of endobronchial needle aspiration during bronchoscopy in exophytic endobronchial lesions: A single-center experience of 810 cases in tertiary care setting
Abstract
INTRODUCTION: Globally, lung cancer is the leading cause of new cancer diagnosis and deaths. Despite advancement in diagnostic modalities lung cancer diagnosis is often delayed due to a lack of bronchoscopy facilities and techniques. In the present study, we have analyzed the role of bronchoscopy in the diagnosis of lung cancer with special emphasis on endobronchial needle aspiration (EBNA) cytology in comparison to other conventional diagnostic techniques (CDTs) such as bronchial wash (BW) and forcep biopsy (FB). METHODS: Prospective, observational study screened 1280 cases with suspected lung malignancy on a clinical and radiological basis. Bronchoscopy-guided techniques such as EBNA, BW, and FB are used in exophytic endobronchial lesions (EELs) in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BW and FB. Rapid on-site evaluation analysis of all EBNA samples done in pathology laboratory allied center. Finally, histopathology proven 810 lung malignancy cases are included in this study. Statistical analysis is done using Chi-square test. RESULTS: In the present study, 810 diagnosed lung cancer patients between 29 and 85 years of age group predominant males 59.25% (480/810) and smokers by addiction in 63.20% (512/810) cases. Presented with cough in 82.09% (665/810), clubbing in 56.17% (455/810) cases, and mass lesion in chest radiograph in 42.22% (342/810) cases. Anatomical location is documented on the right side of tracheobronchial in 59.01% (478/810) cases during bronchoscopy. The yield of FB and FB plus bronchial wash in EEL is 89.25% (723/810) and 93.08% (754/810), respectively. The yield of EBNA, EBNA plus bronchial wash, and EBNA plus FB in EEL is 64.56% (523/810), 67.28% (545/810), and 97.65% (791/810), respectively. Total yield of all fiberoptic bronchoscopy-guided procedures (EBNA + FB + BW) in EEL is 100%. Additional yield of EBNA in EEL over other CDTs is 6.92%. Sensitivity of FB and EBNA in diagnosing lung malignancy in EEL is 89.25% and 64.56%, respectively. FB is more sensitive technique than EBNA in EEL (P < 0.00001). Sensitivity of FB plus bronchial wash in EEL is 93.08% (754/810). Sensitivity of EBNA plus bronchial wash in EEL is 67.28% (545/810). Sensitivity of EBNA plus FB in EEL is 97.65% (791/810) (P < 0.00001). CONCLUSIONS: EBNA has documented very crucial role in diagnosing lung cancer in comparison to other CDTs. Although FB is a more sensitive test than EBNA in EEL in diagnosing disease, we have documented EBNA has significant additive yield in proportionate number of cases. EBNA is safe, sensitive, and cytology samples can give comparable results to histopathology.
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