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

David  Fielding; Andrew J. Dalley; Mahendra  Singh; Lakshmy Nandakumar; Katia Nones; Vanessa Lakis; Haarika Chittoory; Kaltin Ferguson; Farzad Bashirzadeh; Michael Bint; Carl  Pahoff; Jung Hwa  Son; Alan Hodgson; Sowmya  Sharma; David  Godbolt; Kylie  Coleman; Lenore  Whitfield; Nicola Waddell; Sunil R. Lakhani; Peter T. Simpson; Gunter Hartel

doi:10.1016/j.jtocrr.2022.100403

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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

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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

David Fielding, Andrew J. Dalley, Mahendra Singh, Lakshmy Nandakumar, Katia Nones, Vanessa Lakis, Haarika Chittoory, Kaltin Ferguson, Farzad Bashirzadeh, Michael Bint, …

JTO Clinical and Research Reports, Vol.3(10), pp.1-10

2022

DOI: https://doi.org/10.1016/j.jtocrr.2022.100403

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Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) is an important means of obtaining tissue for advanced lung cancer. Optimising the EBUS TBNA needling technique is important to maintain procedural simplicity and maximise 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 (tumour 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 malignant by EBUS TBNA (45M, 41F), 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 (X2 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 >=25% cellularity 86.3% of the time (Kappa of 0.63 (95% CI 0.55, 0.71)). Conclusions: Three agitations is non-inferior 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.

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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
Authors: David Fielding (Corresponding Author) - The University of Queensland
Andrew J. Dalley (Author) - The University of Queensland
Mahendra Singh (Author) - Royal Brisbane and Women's Hospital
Lakshmy Nandakumar (Author) - Royal Brisbane and Women's Hospital
Katia Nones (Author) - QIMR Berghofer Medical Research Institute
Vanessa Lakis (Author) - QIMR Berghofer Medical Research Institute
Haarika Chittoory (Author) - The University of Queensland
Kaltin Ferguson (Author) - The University of Queensland
Farzad Bashirzadeh (Author) - Royal Brisbane and Women's Hospital
Michael Bint (Author) - Sunshine Coast University Hospital
Carl Pahoff (Author) - Gold Coast Hospital
Jung Hwa Son (Author) - Royal Brisbane and Women's Hospital
Alan Hodgson (Author) - Prince Charles Hospital
Sowmya Sharma (Author) - QIMR Berghofer Medical Research Institute
David Godbolt (Author) - Prince Charles Hospital
Kylie Coleman (Author) - Prince Charles Hospital
Lenore Whitfield (Author) - Prince Charles Hospital
Nicola Waddell (Author) - QIMR Berghofer Medical Research Institute
Sunil R. Lakhani (Author) - The University of Queensland
Peter T. Simpson (Author) - The University of Queensland
Gunter Hartel (Author) - QIMR Berghofer Medical Research Institute
Publication details: JTO Clinical and Research Reports, Vol.3(10), pp.1-10
Publisher: Elsevier BV
Date published: 2022
DOI: 10.1016/j.jtocrr.2022.100403
ISSN: 2666-3643
Copyright note: © 2022 Published by Elsevier Inc. on behalf of the International Association for the Study of Lung Cancer. This article is Under a Creative Commons license: https://creativecommons.org/licenses/by-nc-nd/4.0/
Organisation Unit: University of the Sunshine Coast, Queensland
Language: English
Record Identifier: 99668498202621
Output Type: Journal article

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