Abstract
This chapter outlines practical approaches for rapid on-site assessment during fine needle aspiration or biopsy of lung lesions as well as mediastinal lymph nodes. It is important to classify the lesions into inflammatory/infectious, hematopoietic lesions, and non-hematopoietic tumor for appropriate specimen triage. Additional sampling should be recommended for potential ancillary studies/molecular testing if on-site evaluation suggests a non-small cell carcinoma. The chapter provides cytomorphologic features and diagnostic pitfalls of commonly encountered lung lesions.
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References
Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e142S–65S.
Eapen GA, Shah AM, Lei X, Jimenez CA, Morice RC, Yarmus L, Filner J, Ray C, Michaud G, Greenhill SR, Sarkiss M, Casal R, Rice D, Ost DE, American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Participants. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE registry. Chest. 2013;143(4):1044–53.
VanderLaan PA, Wang HH, Majid A, Folch E. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): an overview and update for the cytopathologist. Cancer Cytopathol. 2014;122(8):561–76.
Loo FL, Halligan AM, Port JL, Hoda RS. The emerging technique of electromagnetic navigation bronchoscopy-guided fine-needle aspiration of peripheral lung lesions: promising results in 50 lesions. Cancer Cytopathol. 2014;122(3):191–9.
Ost DE, Ernst A, Lei X, Kovitz KL, Benzaquen S, Diaz-Mendoza J, Greenhill S, Toth J, Feller-Kopman D, Puchalski J, Baram D, Karunakara R, Jimenez CA, Filner JJ, Morice RC, Eapen GA, Michaud GC, Estrada-Y-Martin RM, Rafeq S, Grosu HB, Ray C, Gilbert CR, Yarmus LB, Simoff M, AQuIRE Bronchoscopy Registry. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE registry. Am J Respir Crit Care Med. 2016;193(1):68–77.
Shepherd RW. Bronchoscopic pursuit of the peripheral pulmonary lesion: navigational bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy. Curr Opin Pulm Med. 2016;22(3):257–64.
Mondoni M, Sotgiu G, Bonifazi M, Dore S, Parazzini EM, Carlucci P, Gasparini S, Centanni S. Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis. Eur Respir J. 2016;48(1):196–204.
Nakajima T, Yasufuku K, Saegusa F, Fujiwara T, Sakairi Y, Hiroshima K, Nakatani Y, Yoshino I. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg. 2013;95(5):1695–9.
da Cunha Santos G, Boerner SL, Geddie WR. Maximizing the yield of lymph node cytology: lessons learned from rapid onsite evaluation of image- and endoscopic-guided biopsies of hilar and mediastinal lymph nodes. Cancer Cytopathol. 2011;119(6):361–6.
Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ando M. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration. 2013;85(6):486–92.
Kubik MJ, Bovbel A, Goli H, Saremian J, Siddiqi A, Masood S. Diagnostic value and accuracy of imprint cytology evaluation during image-guided core needle biopsies: review of our experience at a large academic center. Diagn Cytopathol. 2015;43(10):773–9.
Jain D, Allen TC, Aisner DL, Beasley MB, Cagle PT, Capelozzi VL, Hariri LP, Lantuejoul S, Miller R, Mino-Kenudson M, Monaco SE, Moreira A, Raparia K, Rekhtman N, Roden AC, Roy-Chowdhuri S, da Cunha Santos G, Thunnissen E, Troncone G, Vivero M. Rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspirations for the diagnosis of lung cancer: a perspective from Members of the Pulmonary Pathology Society. Arch Pathol Lab Med. 2018;142(2):253–62.
Yarmus L, Akulian J, Gilbert C, Feller-Kopman D, Lee HJ, Zarogoulidis P, Lechtzin N, Ali SZ, Sathiyamoorthy V. Optimizing endobronchial ultrasound for molecular analysis. How many passes are needed? Ann Am Thorac Soc. 2013;10(6):636–43.
Trisolini R, Cancellieri A, Tinelli C, de Biase D, Valentini I, Casadei G, Paioli D, Ferrari F, Gordini G, Patelli M, Tallini G. Randomized trial of endobronchial ultrasound-guided transbronchial needle aspiration with and without rapid on-site evaluation for lung cancer genotyping. Chest. 2015;148(6):1430–7.
Stoy SP, Segal JP, Mueller J, Furtado LV, Vokes EE, Patel JD, Murgu S. Feasibility of endobronchial ultrasound-guided transbronchial needle aspiration cytology specimens for next generation sequencing in non-small-cell lung cancer. Clin Lung Cancer. 2018;19(3):230–8.
Layfield LJ, Baloch Z, Elsheikh T, Litzky L, Rekhtman N, Travis WD, Zakowski M, Zarka M, Geisinger K. Standardized terminology and nomenclature for respiratory cytology: the Papanicolaou Society of Cytopathology guidelines. Diagn Cytopathol. 2016;44(5):399–409.
Suen KC, Abdul-Karim FW, Kaminsky DB, et al. Guidelines of the Papanicolaou Society of Cytopathology for the examination of cytologic specimens obtained from the respiratory tract. Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Diagn Cytopathol. 1999;21(1):61–9.
Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, Johnson MM, Al-Haddad MA, Gross SA, Pungpapong S, Hardee JN, Odell JA. Minimally invasive endoscopic staging of suspected lung cancer. JAMA. 2008;299(5):540–6.
Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy. 2015;47(6):545–59.
Navani N, Nankivell M, Lawrence DR, Lock S, Makker H, Baldwin DR, Stephens RJ, Parmar MK, Spiro SG, Morris S, Janes SM, Lung-BOOST Trial Investigators. Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial. Lancet Respir Med. 2015;3(4):282–9.
Alsharif M, Andrade RS, Groth SS, Stelow EB, Pambuccian SE. Endobronchial ultrasound-guided transbronchial fine-needle aspiration: the University of Minnesota experience, with emphasis on usefulness, adequacy assessment, and diagnostic difficulties. Am J Clin Pathol. 2008;130(3):434–43.
Nayak A, Sugrue C, Koenig S, Wasserman PG, Hoda S, Morgenstern NJ. Endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA): a proposal for on-site adequacy criteria. Diagn Cytopathol. 2012;40(2):128–37.
Hughes JH, Young NA, Wilbur DC, Renshaw AA, Mody DR, Cytopathology Resource Committee, College of American Pathologists. Fine-needle aspiration of pulmonary hamartoma: a common source of false-positive diagnoses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med. 2005;129(1):19–22.
Hosler GA, Steinberg DM, Sheth S, Hamper UM, Erozan YS, Ali SZ. Inflammatory pseudotumor: a diagnostic dilemma in cytopathology. Diagn Cytopathol. 2004;31(4):267–70.
Hummel P, Cangiarella JF, Cohen JM, Yang G, Waisman J, Chhieng DC. Transthoracic fine-needle aspiration biopsy of pulmonary spindle cell and mesenchymal lesions: a study of 61 cases. Cancer. 2001;93(3):187–98.
Zeng J, Zhou F, Wei XJ, Kovacs S, Simsir A, Shi Y. Sclerosing hemangioma: a diagnostic dilemma in fine needle aspiration cytology. Cytojournal. 2016;13:9.
Kadota K, Villena-Vargas J, Yoshizawa A, Motoi N, Sima CS, Riely GJ, Rusch VW, Adusumilli PS, Travis WD. Prognostic significance of adenocarcinoma in situ, minimally invasive adenocarcinoma, and nonmucinous lepidic predominant invasive adenocarcinoma of the lung in patients with stage I disease. Am J Surg Pathol. 2014;38(4):448–60.
Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, Chirieac LR, Dacic S, Duhig E, Flieder DB, Geisinger K, Hirsch FR, Ishikawa Y, Kerr KM, Noguchi M, Pelosi G, Powell CA, Tsao MS, Wistuba I, WHO Panel. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10(9):1243–60.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med. 2013;137(5):668–84.
Yildiz-Aktas IZ, Sturgis CD, Barkan GA, Souers RJ, Fraig MM, Laucirica R, Khalbuss WE, Moriarty AT. Primary pulmonary non-small cell carcinomas: the College of American Pathologists Interlaboratory Comparison Program confirms a significant trend toward subcategorization based upon fine-needle aspiration cytomorphology alone. Arch Pathol Lab Med. 2014;138(1):65–70.
Crapanzano JP, Loukeris K, Borczuk AC, Saqi A. Cytological, histological, and immunohistochemical findings of pulmonary carcinomas with basaloid features. Diagn Cytopathol. 2011;39(2):92–100.
Wong PW, Stefanec T, Brown K, White DA. Role of fine-needle aspirates of focal lung lesions in patients with hematologic malignancies. Chest. 2002;121(2):527–32.
Ko HM, Geddie WR, Boerner SL, Rogalla P, da Cunha Santos G. Cytomorphological and clinicopathological spectrum of pulmonary marginal zone lymphoma: the utility of immunophenotyping, PCR and FISH studies. Cytopathology. 2014;25(4):250–8.
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Cai, G. (2019). Lung. In: Cai, G., Adeniran, A. (eds) Rapid On-site Evaluation (ROSE). Springer, Cham. https://doi.org/10.1007/978-3-030-21799-0_10
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DOI: https://doi.org/10.1007/978-3-030-21799-0_10
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