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
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 molecul...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-10-01
|
| Series: | JTO Clinical and Research Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364322001278 |
| _version_ | 1811246388126679040 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | David Fielding, FRACP, MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T14:52:43Z |
| format | Article |
| id | doaj.art-a6f1ee6dc77241f38149b13163b10713 |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-04-12T14:52:43Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-a6f1ee6dc77241f38149b13163b107132022-12-22T03:28:23ZengElsevierJTO Clinical and Research Reports2666-36432022-10-01310100403Prospective 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 YieldDavid Fielding, FRACP, MD0Andrew J. Dalley, PhD1Mahendra Singh, FRCPA2Lakshmy Nandakumar, FRCPA3Katia Nones, PhD4Vanessa Lakis, MBioinf5Haarika Chittoory, MBiotech6Kaltin Ferguson7Farzad Bashirzadeh, FRACP8Michael Bint, FRACP9Carl Pahoff, FRACP10Jung Hwa Son, RN11Alan Hodgson, CT ASC12Sowmya Sharma, FRCPA13David Godbolt, FRCPA14Kylie Coleman, CT ASC15Lenore Whitfield, CT ASC16Nicola Waddell, PhD17Sunil R. Lakhani, FRCPA18Gunter Hartel, PhD19Peter T. Simpson, PhD20Department of Thoracic Medicine, The Royal Brisbane & Women’s Hospital, Brisbane, Australia; UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Corresponding author, Address for correspondence: David Fielding, FRACP, MD, Department Thoracic Medicine, The Royal Brisbane & Women’s Hospital, Brisbane, Australia.UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, AustraliaPathology Queensland, The Royal Brisbane & Women’s Hospital, Brisbane, AustraliaPathology Queensland, The Royal Brisbane & Women’s Hospital, Brisbane, AustraliaQIMR Berghofer Medical Research Institute, Brisbane, AustraliaQIMR Berghofer Medical Research Institute, Brisbane, AustraliaUQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, AustraliaUQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, AustraliaDepartment of Thoracic Medicine, The Royal Brisbane & Women’s Hospital, Brisbane, AustraliaDepartment of Thoracic Medicine, Sunshine Coast University Hospital, Birtinya, AustraliaDepartment of Respiratory Medicine, Gold Coast University Hospital, Southport, AustraliaDepartment of Thoracic Medicine, The Royal Brisbane & Women’s Hospital, Brisbane, AustraliaPathology Queensland, Prince Charles Hospital, Brisbane, AustraliaQIMR Berghofer Medical Research Institute, Brisbane, Australia; Medlab Pathology (ACL) Auburn, Sydney, AustraliaPathology Queensland, Prince Charles Hospital, Brisbane, AustraliaPathology Queensland, Prince Charles Hospital, Brisbane, AustraliaPathology Queensland, Prince Charles Hospital, Brisbane, AustraliaQIMR Berghofer Medical Research Institute, Brisbane, AustraliaUQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Pathology Queensland, The Royal Brisbane & Women’s Hospital, Brisbane, AustraliaQIMR Berghofer Medical Research Institute, Brisbane, AustraliaUQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, AustraliaIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S2666364322001278Cytology smearsMolecular testingLung cancerEBUS TBNA |
| spellingShingle | 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 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 JTO Clinical and Research Reports Cytology smears Molecular testing Lung cancer EBUS TBNA |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Cytology smears Molecular testing Lung cancer EBUS TBNA |
| url | http://www.sciencedirect.com/science/article/pii/S2666364322001278 |
| work_keys_str_mv | AT davidfieldingfracpmd prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT andrewjdalleyphd prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT mahendrasinghfrcpa prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT lakshmynandakumarfrcpa prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT katianonesphd prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT vanessalakismbioinf prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT haarikachittoorymbiotech prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT kaltinferguson prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT farzadbashirzadehfracp prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT michaelbintfracp prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT carlpahofffracp prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT junghwasonrn prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT alanhodgsonctasc prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT sowmyasharmafrcpa prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT davidgodboltfrcpa prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT kyliecolemanctasc prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT lenorewhitfieldctasc prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT nicolawaddellphd prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT sunilrlakhanifrcpa prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT gunterhartelphd prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield AT petertsimpsonphd prospectiveoptimizationofendobronchialultrasoundguidedtransbronchialneedleaspirationlymphnodeassessmentforlungcancerthreeneedleagitationsarenoninferiorto10agitationsforadequatetumorcellanddnayield |