Ankara University School of Medicine Department of Thoracic Surgery Ankara
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Transcript of Ankara University School of Medicine Department of Thoracic Surgery Ankara
TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY (TBNAB) AND THE VALUE OF ON-SITE CYTOPATHOLOGICAL EXAMINATION FOR LUNG
CANCER AND MEDIASTINAL LYMPHADENOPATY: “85 CASES”
Serkan ENÖN, Cabir YÜKSEL, Koray CEYHAN, Ayten KAYI CANGIR, Nezih ÖZDEMİR, Murat AKAL
Ankara University School of Medicine
Department of Thoracic Surgery Ankara
TBNA
• 1950 Brouet and Euler: Rigid bronchoscopy
• 1978 Wang: Flexible bronchoscopy
TBNAB
Diagnosis and staging of lung cancer Diagnosis of mediastinal
lymphadenopathy Alternative to mediastinoscopy? Less invasive Cost effective Secure Diagnostic procedure
TBFNAB is not performed worldwide
• In 1990’s it is performed in US %12, • in UK % 27• Recent years % 54
WHY ? Difficult technique Experimentation need No onsite diagnosis Low specificity and sensitivity
AIM
Aim of this study is to determine the diagnostic value of TBNAB and on-site cytopathological examination
PATIENTS-METHODS
February 2004 - February 2007 Ankara University School of Medicine,
Department of Thoracic Surgery TBNAB was performed to 85 cases
with lung cancer and mediastinal LAP
PATIENTS-METHODS
• Under general anesthesia, laryngeal mask
• FOB and 12mm length/19-22G Wang needles,
• Accompanying same cytopathologist.
PATIENTS-METHODS
• During the operation, sufficiency assignment was done by the cytopathologist through the biopsy materials.
• Finding out lymphoid cells or tumor infiltration was accepted as a sufficiency criteria.
• Surgical procedures were done in other cases not including these criteria, then.
RESULTS
•Male : 57 (%67,1)•Female : 28 (%32,9)
•Age(med) : 51,74(14-76)
RESULTS
–47 malign (%55,3)
–38 benign (%44,7)
MALİGN CASES:47
(%)
– Adenocarsinoma...................................: 16 %34– Squamaus cell carsinoma....................: 13 %27,7– Small cell cancer..................................: 9 %19,2– Large cell carsinoma...........................: 5 %10,7– Non small cell carsinoma ..................: 1 %2,1– Hodgkin disease...................................: 2 %4,2– Malign peripheral nerve sheat tm...: 1 %2,1
BENIGN CASES: 38
Granuloma:28 (%73,7)•18 sarcoidosis •7 tuberculosis •2 reactive granuloma(tm or Behçet disease
reaktive ) •1 granulomateous angitis
Reaktive lymphoid hyperplazi:10 (%26,3)
THE RATIO OF DIAGNOSIS
• MALIGN: 46/47 (%97,87) – Non-diagnostic : 1 patient -> biopsy
LCNEC
• BENIGN: 32/38 (%84.21) – Non diagnostic: 6 patients
• 3 tbc (2 necrosis, 1 reaktive lymphoid hyperplasia)
• 3 reaktive lymphoid hyperplasia)
Difficulty in diagnosis: 7 pts
• 4 non-diagnostic (on-site)– 3 reaktive lymphoid hyperplasia – 1 large cell carsinoma
• 2 necrosis (on-site)– Tissue diagnosis: tbc
• 1 reaktive lymphoid hyperplasia (on-site) – Tissue diagnosis: tbc
TOTAL
• Correct Diagnosis 78/85 ( %91.76)
EVALUATION OF LYMPH NODES
• Lymph node size :22,75 mm (7-70 mm)
• Lymph n ode biopsy n: 126• Correct diagnosis n: 104
• Diagnostic ratio: 104/126 (%82.53)
CORRECT DIAGNOSIS ACCORDING TO LYMPH NODES
• Lymph node no 2 : 14/17 (%82,4)• Lymph node no 3 : 7/12 (%58,3)• Lymph node no 4 : 10/15 (%66,7)• Lymph node no 7 : 66/74 (%89,2)• Lymph node no 10 : 2/2 (%100)• Lymph node no 11 : 5/6 (%83,3)
Method Sensitivity %
Spesivity %
FalsePositive(%)
False Negative(%)
Mediastinoscopy 81 100 0 9
Chamberlein 87 100 0 15
TTNA 91 100 0 22
EUS-NA 88 91 2 23
TBNA(910 pts) 76 96 0 29
How should be correct diagnosis of TBNAB increased?
• Experience – Min 2-3 years and 50 TBNAB
• Size of LAP – > 20 mm diagnostic ratio %80
• Number of procedure– At least 5
• Localisation of LAP – Subkarinal LAP
How should be the sensitivity of TBNAB increased?
• Diamater of the needle – 18-19 g : Able to co-investigation of cytology and
histology
• Radiological support– Endobronchial USG, BT-fluroscopy , Endoscopic
USG
• Accompaniment of cytopatholog (on-site cytopathologic examination)
On-site cytopathologic examination
• Decreases inadequate results • Prevents unncessary manipulations
therefore minimizes the complications
• Increases the sensivity significantly (%50 %80)
CONCLUSION
TBNAB is an efficient and reliable method for diagnosing and/or staging the lung cancers and mediastinal LAP
CONCLUSION
The ability and experience of bronchoscopist and on-site cytopathologic examination are the most important factors for the success of procedure
CONCLUSION
• When these factors come together, diagnostic accuracy increases over 90% and the patients can be preserved from invasive surgical procedures such as mediastinoscopy or thoracotomy.