EBUS-TBNA: A 2-Year Experience from a Tertiary Pathology Centre with Cyto-Histological Correlation

Endoscopic ultrasound-guided fine-needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) methods are expanding due to their minimally invasive nature using real-time image guidance, a low incidence of complications, and a diagnostic rate ranging from 89% to 93.6%. The application of EBUS-TBNA was able to downgrade 40% of patients with suspicion of stage III lung cancer on PET scan.

In the present study, we analysed the diagnostic outcomes of EBUS cytology at the Laboratory of Pathology, Fimlab Laboratories, Tampere, Finland, during a 2-year period. In our analysis, 1176 EBUS samples from 486 patients that underwent EBUS-TBNA in Tampere University Hospital (TAYS) from January 2017 to December 2018 were reviewed. The mean age of the patients was 64 ± 14 (SD) years with the age range from 19 to 90 years. Cytospin cytology slides stained by Papanicolaou stain and cell blocks were performed in each sample. Further immunohistochemical stains were ordered by the pathologist on demand.

The diagnostic yield was 89.5% and the diagnostic accuracy was 77.9% in the present study. The sensitivity for malignancy in EBUS-TBNA diagnosis was 95.69% and the negative predictive value 96.75%. Cyto-histopathological diagnosis correlation was 54.7% (95% confidence interval [CI]: 40.6%-66.4%, p < 0.001), and the histological accuracy compared to the exact original diagnosis was 43.5%. When considering the histological diagnoses that support the original diagnosis, the correlation was 61.3% (95% CI: 48.4%-71.5%, p < 0.001) and the accuracy was 72.2%. The overall inadequate rate of EBUS-TBNA samples in this study was 10.5%.

The EBUS-TBNA diagnostic yield, diagnostic accuracy, and inadequate rate in the present study are in line with previously published studies.