Original Article
The Contribution of Cell Blocks in the Diagnosis of Mediastinal Masses and Hilar Adenopathy Samples From Echobronchoscopy
Aportación del bloque celular en el diagnóstico de adenopatías y masas mediastínicas o hiliares realizado por ecobroncoscopia
Tamara Lourido-Cebreiroa, Virginia Leiro-Fernándeza, Antoni Tardio-Baigesb, Maribel Botana-Riala, Manuel Núñez-Delgadoa, M. Jesús Álvarez-Martínb, Alberto Fernández-Villara,
Corresponding author
a Servicio de Neumología, Instituto de Investigación Biomédica de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
b Servicio de Anatomía Patológica, Instituto de Investigación Biomédica de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
Read
7344
Timeswas read the article
2227
Total PDF
5117
Total HTML
Share statistics
array:24 [ "pii" => "S1579212914001426" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.05.006" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "882" "copyright" => "SEPAR" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2014;50:267-71" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3496 "formatos" => array:3 [ "EPUB" => 144 "HTML" => 2610 "PDF" => 742 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289613003621" "issn" => "03002896" "doi" => "10.1016/j.arbres.2013.11.022" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "882" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2014;50:267-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8228 "formatos" => array:3 [ "EPUB" => 121 "HTML" => 6697 "PDF" => 1410 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Aportación del bloque celular en el diagnóstico de adenopatías y masas mediastínicas o hiliares realizado por ecobroncoscopia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "267" "paginaFinal" => "271" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The Contribution of Cell Blocks in the Diagnosis of Mediastinal Masses and Hilar Adenopathy Samples From Echobronchoscopy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3653 "Ancho" => 1603 "Tamanyo" => 413714 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Procesado de muestras.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A)<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Procesado de muestra citológica.</span> A.1)<span class="elsevierStyleHsp" style=""></span>El material de punción se deposita sobre un cristal. A.2)<span class="elsevierStyleHsp" style=""></span>Con ayuda de otro porta se procede al extendido y posteriormente se dejará secar. A.3)<span class="elsevierStyleHsp" style=""></span>Tinción rápida de Diff-Quick. A.4)<span class="elsevierStyleHsp" style=""></span>Evaluación patológica in situ. A.5)<span class="elsevierStyleHsp" style=""></span>Ejemplo de un extendido citológico de carcinoma epidermoide.</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">B)<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Elaboración del bloque celular.</span> B.1)<span class="elsevierStyleHsp" style=""></span>El material obtenido de la punción que contiene restos hemáticos y microfragmentos de tejido se deja coagular. B.2)<span class="elsevierStyleHsp" style=""></span>El coágulo formado de fijará en formol. B.3)<span class="elsevierStyleHsp" style=""></span>Posteriormente se incluirá en parafina para ser procesado como una muestra de biopsia. B.4)<span class="elsevierStyleHsp" style=""></span>Cristal con muestra de bloque celular. B.5)<span class="elsevierStyleHsp" style=""></span>Ejemplo de imagen microscópica del bloque celular de un carcinoma epidermoide.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tamara Lourido-Cebreiro, Virginia Leiro-Fernández, Antoni Tardio-Baiges, Maribel Botana-Rial, Manuel Núñez-Delgado, M. Jesús Álvarez-Martín, Alberto Fernández-Villar" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Tamara" "apellidos" => "Lourido-Cebreiro" ] 1 => array:2 [ "nombre" => "Virginia" "apellidos" => "Leiro-Fernández" ] 2 => array:2 [ "nombre" => "Antoni" "apellidos" => "Tardio-Baiges" ] 3 => array:2 [ "nombre" => "Maribel" "apellidos" => "Botana-Rial" ] 4 => array:2 [ "nombre" => "Manuel" "apellidos" => "Núñez-Delgado" ] 5 => array:2 [ "nombre" => "M. Jesús" "apellidos" => "Álvarez-Martín" ] 6 => array:2 [ "nombre" => "Alberto" "apellidos" => "Fernández-Villar" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212914001426" "doi" => "10.1016/j.arbr.2014.05.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001426?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613003621?idApp=UINPBA00003Z" "url" => "/03002896/0000005000000007/v1_201406200113/S0300289613003621/v1_201406200113/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S157921291400144X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.05.008" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "895" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2014;50:272-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3124 "formatos" => array:3 [ "EPUB" => 142 "HTML" => 2314 "PDF" => 668 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Prevalence of Chronic Obstructive Pulmonary Disease in the Canary Islands" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "272" "paginaFinal" => "277" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1093 "Ancho" => 1583 "Tamanyo" => 112638 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study flow chart, showing the stages between the sample of all eligible subjects and the final sample in which the prevalence of COPD was established.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Cabrera López, Gabriel Juliá Serdá, Cristina Cabrera Lacalzada, Ana Martín Medina, José Antonio Gullón Blanco, Miguel Ángel García Bello, Pedro Cabrera Navarro" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Cabrera López" ] 1 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Juliá Serdá" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Cabrera Lacalzada" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Martín Medina" ] 4 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Gullón Blanco" ] 5 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "García Bello" ] 6 => array:2 [ "nombre" => "Pedro" "apellidos" => "Cabrera Navarro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614000076" "doi" => "10.1016/j.arbres.2013.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614000076?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291400144X?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000007/v1_201406290026/S157921291400144X/v1_201406290026/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212914001281" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.04.006" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "897" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2014;50:265-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2701 "formatos" => array:3 [ "EPUB" => 136 "HTML" => 2008 "PDF" => 557 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Questionnaires in Multidimensional Assessment of Chronic Obstructive Pulmonary Disease: Two Sides of the Same Coin" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "266" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuestionarios en la valoración multidimensional de la enfermedad pulmonar obstructiva crónica: dos caras de la misma moneda" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Luis López Campos, Carmen Calero" "autores" => array:2 [ 0 => array:2 [ "nombre" => "José Luis" "apellidos" => "López Campos" ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Calero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614000271" "doi" => "10.1016/j.arbres.2013.12.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614000271?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001281?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000007/v1_201406290026/S1579212914001281/v1_201406290026/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "The Contribution of Cell Blocks in the Diagnosis of Mediastinal Masses and Hilar Adenopathy Samples From Echobronchoscopy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "267" "paginaFinal" => "271" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Tamara Lourido-Cebreiro, Virginia Leiro-Fernández, Antoni Tardio-Baiges, Maribel Botana-Rial, Manuel Núñez-Delgado, M. Jesús Álvarez-Martín, Alberto Fernández-Villar" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Tamara" "apellidos" => "Lourido-Cebreiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Virginia" "apellidos" => "Leiro-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Antoni" "apellidos" => "Tardio-Baiges" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Maribel" "apellidos" => "Botana-Rial" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Manuel" "apellidos" => "Núñez-Delgado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M. Jesús" "apellidos" => "Álvarez-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:4 [ "nombre" => "Alberto" "apellidos" => "Fernández-Villar" "email" => array:1 [ 0 => "alberto.fernandez.villar@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Instituto de Investigación Biomédica de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Instituto de Investigación Biomédica de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aportación del bloque celular en el diagnóstico de adenopatías y masas mediastínicas o hiliares realizado por ecobroncoscopia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3654 "Ancho" => 1603 "Tamanyo" => 402067 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Processing of samples. (A) <span class="elsevierStyleItalic">Cytological smear processing.</span> (A.1) Aspirated material discharged on a slide. (A.2) It is smeared with the aid of another slide and then left to dry. (A.3) Diff-Quick staining. (A.4) Rapid on-site evaluation. (A.5) Example of an epidermoid carcinoma cytology smear. (B) <span class="elsevierStyleItalic">Preparation of the cell block.</span> (B.1) Aspirate material containing bloody remains and tissue microfragments is left to clot. (B.2) The clot is fixed in formol. (B.3) It is then set in paraffin for processing as a biopsy specimen. (B.4) Slide with cell block specimen. (B.5) Microscopic image of an epidermoid carcinoma cell block.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The recent introduction and generalized use of new diagnostic and staging tools, particularly positron emission tomography combined with computed tomography (PET-CT) and endoscopic ultrasound (EUS), have improved efficiency in the diagnosis of mediastinal node involvement, sidelining the use of more aggressive and costly tests such as surgical examination of the mediastinum.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The incorporation of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has led to a considerable improvement in the validity and the safety of this relatively non-invasive diagnostic test, while maintaining an excellent cost-effectiveness ratio.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Although all these technological advances have improved the diagnostic yield of cytohistological samples, insofar as the sampling of adequate material for diagnosis is concerned, the rate of false negatives is as high as 20% in most published series.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Preparation of a cell block with the cytological sample may provide additional morphological information and allow both immunohistochemical and molecular techniques to be performed, thus helping improve histological subtyping and even targeted therapies.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–11</span></a> It may also help identify benign diseases that normally need larger specimens for diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On this basis, the aim of this study was to analyze the contribution made by cell blocks to conventional cytological smear obtained by EBUS-TBNA in the diagnosis of lymphadenopathies and mediastinal and hilar masses.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective observational study of a prospectively collected series in which the capacity to generate cell blocks from cytological specimens obtained by EBUS-TBNA from hilar and mediastinal lymphadenopathies and/or pulmonary lesions and their additional diagnostic value were analyzed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">The pathology reports from the EBUS-TBNA performed in patients with hilar and/or mediastinal lymphadenopathies with a short axis >1<span class="elsevierStyleHsp" style=""></span>cm on CT or 5<span class="elsevierStyleHsp" style=""></span>mm in the case of pathological uptake on PET-CT or with accessible lung lesions, in whom an etiological diagnosis was determined, were reviewed. All procedures were performed consecutively between September 2009 and December 2011 in the Complexo Hospitalario de Vigo, a tertiary level hospital with a referral area of 350<span class="elsevierStyleHsp" style=""></span>000 inhabitants, and 800<span class="elsevierStyleHsp" style=""></span>000 inhabitants specifically for this technique, since neighboring towns with secondary level referral hospitals are also included. EBUS-TBNA was indicated for staging or diagnosis of lung cancer or extrathoracic lesions, and the study of mediastinal or hilar masses/lymphadenopathies of undetermined etiology. Specific informed consent for participation in the study was obtained in writing from all patients. The study was approved by the ethics committee of the region (Research Ethics Committee of Galicia).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">EBUS-TBNA and Evaluation of Specimens</span><p id="par0030" class="elsevierStylePara elsevierViewall">All procedures were performed in an outpatient setting in the conventional bronchoscopy room, with echocardiographic, pressure and pulse oximeter monitoring, under conscious sedation with midazolam and fentanyl. All procedures were performed by a team of 3 pulmonologists, a nurse and a nursing assistant with wide experience in the technique.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> A BF-UC180F-OL8 bronchoscope (Olympus, Japan) and an Aloka Prosound alpha 5 endoscope (Aloka, Japan) were used. After endoscopic examination, the lesion was measured and aspirated using NA2015X-4022 needles (Olympus, Japan). Between 1 and 3 passes through the lymphadenopathy, depending on the immediate results. An expert pathologist was present during all procedures to perform rapid on-site evaluation (ROSE) on all specimens after drying and Diff-Quick staining. Another part of the specimen was fixed in alcohol, and if clots or abundant hematic material or tissue microfragments were obtained, these were fixed with formaldehyde and placed in paraffin to make a cell block. Cytological specimens were systematically stained according to the Papanicolaou method, and histological specimens were stained with hematoxylin and eosin.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Specimens were considered acceptable when they contained abundant lymphocytes or lymphoid tissue indicative of lymph node, malignant cells or findings suitable for the determination of another specific diagnosis (diagnostic specimens). The specimens were analyzed by the same pathologists who carried out the ROSE. Suspicious and inconclusive specimens were not included, nor were those with a diagnosis of anthracosis. In addition to the etiological diagnoses, sociodemographic variables, type, site and size of the aspirated lesion, the feasibility of preparing cell blocks and their contribution to the morphological diagnosis and their utility for performing immunohistochemical studies were recorded.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical Analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Overall results were expressed in percentages and absolute frequencies for qualitative variables and as mean and standard deviation (SD) for quantitative variables. The diagnostic value of the procedures was analyzed with McMemar's exact test, using a two-tailed level of significance of 0.05. The data were analyzed using the <span class="elsevierStyleItalic">Statistical Package for Social Sciences</span> software, version 15.0 (SPSS, Chicago, IL, USA). For the descriptive study, both lymphadenopathy and patient were taken as an analysis unit. For the purposes of the comparative study, each lymphadenopathy was used as an analysis unit.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 129 EBUS-TBNA specimens from 110 patients, retrieved from various node stations and corresponding masses, were included in the study. Patient characteristics and the aspirated lymphadenopathies and masses (9 pulmonary and one esophageal) are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. In 81% of the patients, the diagnosis was lung cancer, in 10% extrapulmonary cancer, in 5.4% sarcoidosis, in 2.7% lymphomas and in 0.9% tuberculosis. The most frequently aspirated lesions were 4R (28%) and subcarinal (21%) lymphadenopathies. Lesion diameter on EUS was 15.6<span class="elsevierStyleHsp" style=""></span>mm (SD: 7) and the number of passes through the lymphadenopathy/mass was 2.19 (SD: 0.9). A cell block could be prepared from 72% of the specimens. Cytology was the method for determining diagnosis in 99.1% of cancers and in 75% of benign disease. No relationship was found between the aspirated lymph node and positivity of results. In 52.6% of the cell blocks, immunohistochemical techniques could be performed, contributing to histological typing, compared to 14% of the cytological smears (<span class="elsevierStyleItalic">P</span><.0001). In 4 patients, the cell block was the only specimen that permitted a morphological diagnosis: benign disease in 3 cases and extrapulmonary metastasis in the other (3 sarcoidosis and one prostate adenocarcinoma metastasis). Diagnosis exclusively from the cell block was significantly more common for benign disease than malignant disease (25% vs 0.9%, lymphadenopathy analysis; <span class="elsevierStyleItalic">P</span>=.002). In 50% of cases of sarcoidosis, diagnosis was obtained from the cell block. In three patients with a diagnosis of malignant disease (1 NOS [non-specific carcinoma], 1 epidermoid carcinoma and 1 adenocarcinoma) with the conventional cytological smear, the cell block provided a diagnosis of the tumor strain. In two cases, the diagnosis was extrapulmonary metastasis (esophageal squamous cell carcinoma and colon adenocarcinoma) and one case it was lung adenocarcinoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The results of our study show that cell blocks contribute significantly to immunohistochemical techniques, leading to improved cell typing of cancers, and in some cases can also provide exclusive morphological diagnoses, particularly for granulomatous diseases (42.8% of all benign diseases in this study). The improved diagnostic yield of the cell block in benign disease is due to the fact that when the specimen is allowed to clot, the cell material from which morphological features are identified is concentrated, and this may aid the diagnosis of granulomatous diseases and lymphoma.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The cell block may be prepared from the aspirated material discharged into saline solution or after the material has coagulated. Yung et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> compared the diagnostic yield of both techniques and found that the cell block prepared from the clot (the technique used by the authors) significantly increased diagnostic effectiveness, without changing the cytomorphological features of the specimen. The presence of a pathologist minimizes the number of inadequate specimens and can indicate the need for repeat sampling if the preparation of a cell block is required. Recently, Oki et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> carried out a comparative study on the contribution of ROSE in a group of 120 patients, showing a reduced need for repetition of procedures and a lower number of passes through the lesion in the EBUS-TBNA<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ROSE group. In this series, the cell block contributed exclusively to the diagnosis and/or characterization of the disease in 5.4% (7 of 129) of patients. Several studies have shown the utility of EBUS-TBNA for the diagnosis of mediastinal and hilar lymphadenopathies and masses, particularly in malignant disease, and the greater utility of the cell block in immunohistochemical and even molecular studies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,13,15–19</span></a> Bulman et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> found that a histological etiology could be determined from the cell block in 85% of NOS specimens and molecular studies could be performed. Similarly to the findings of the authors, the cell block greatly facilitated immunohistochemical techniques, even if no exclusive morphological diagnosis was determined from this specimen. In other publications in which cytological diagnosis by EBUS-TBNA is compared to other techniques, such as surgery, bronchial biopsy or blind transbronchial aspiration, greater concordance is shown in cases in which a cell block was obtained.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15–17</span></a> With respect to the usefulness of these specimens in benign disease, there appears to be a general increase in yield,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> although the only entity in which they have been specifically studied is sarcoidosis.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19–22</span></a> Early studies were performed with aspirations carried out with esophageal ultrasound.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a> Von Bartheld et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> found that in patients with a final diagnosis of sarcoidosis, 33% of the negative cytologies revealed granulomas in the cell block. Iwashita et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> also found that diagnoses of sarcoidosis increased from 77.8% to 94.4% when determined with cell block. Schwartz et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> were able to diagnose sarcoidosis in 96% of cases exclusively on the basis of the cell block. In this study, the diagnosis could be determined from the cell block in 3 patients with sarcoidosis. With respect to tuberculosis, the specific contribution of EBUS-TBNA to the diagnosis of this disease is not clear.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Thus, the results of this study coincide with the results previously reported in the cited studies.</p><p id="par0050" class="elsevierStylePara elsevierViewall">This study has a series of limitation that should be mentioned. Firstly, its retrospective nature may allow bias in selection of cases and data. However, this is minimal, since all EBUS-TBNA and the corresponding diagnostic pathological reports made prospectively during the study period were included; the existence of a reliable case source, therefore, adds to the internal validity of the study. Secondly, the study was not blinded, and analyses of the specimens obtained both for standard cytology and for the cell block were performed by the same pathologist; therefore interpretation, particularly of the cytology, could be influenced by the results of the cell block, enhancing its diagnostic value. However, despite this possible advantage for cytology, the study found that the cell block has additional diagnostic value, particularly for benign diseases. Finally, the presence of the pathologist reduces the possible bias of insufficient sampling, since suitability of the specimens was determined by the pathologist during the procedure.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It can be concluded that a cell block can be prepared from a high percentage of cytological specimens from clotted material obtained by EBUS-TBNA. The cell block greatly facilitates immunohistochemical techniques and provides additional data, leading to better diagnostics and improved histological typing of cancers, and has been shown to be useful in the endobronchial diagnosis of node involvement due to benign disease.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Specific Contribution of Each of the Authors</span><p id="par0060" class="elsevierStylePara elsevierViewall">Study concept and design: Fernández-Villar, Lourido-Cebreiro.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patient inclusion: Lourido-Cebreiro, Leiro-Fernández, Núñez-Delgado, Botana-Rial, Fernández-Villar.</p><p id="par0070" class="elsevierStylePara elsevierViewall">EBUS-TBNA performance: Leiro-Fernández, Fernández-Villar, Núñez-Delgado, Botana-Rial, Lourido-Cebreiro.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Pathological analysis: Tardío-Baiges, Álvarez-Martín.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Case review: Lourido-Cebreiro, Leiro-Fernández, Fernández-Villar.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: Lourido-Cebreiro, Leiro-Fernández, Fernández-Villar, Tardío-Baiges, Álvarez-Martín, Botana-Rial.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Statistical analysis: Lourido-Cebreiro, Fernández-Villar.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Manuscript preparation: Lourido-Cebreiro, Leiro-Fernández, Fernández-Villar.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Critical review of manuscript: Núñez-Delgado, Botana-Rial.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Study supervision: Fernández-Villar.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres349279" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec330942" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres349280" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Metodología" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec330941" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methodology" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patients" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "EBUS-TBNA and Evaluation of Specimens" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Specific Contribution of Each of the Authors" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-17" "fechaAceptado" => "2013-11-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec330942" "palabras" => array:5 [ 0 => "Endobronchial ultrasound" 1 => "Transbronchial aspiration" 2 => "Cell block" 3 => "Mediastinal and hilar adenopathies" 4 => "Neoplastic disease" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec330941" "palabras" => array:5 [ 0 => "Ecografía endobronquial" 1 => "Punción aspiración transbronquial" 2 => "Bloque celular" 3 => "Adenopatías mediastínicas e hiliares" 4 => "Enfermedad neoplásica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cell block material from puncture can be obtained with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in many cases. The aim of this study was to analyze the value of additional information from cell blocks obtained with EBUS-TBNA samples from mediastinal and hilar lymph nodes and masses.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Review of pathology reports with a specific diagnosis obtained from EBUS-TBNA samples of mediastinal or hilar lesions, prospectively obtained over a two-year period. The generation of cell blocks from cytology needle samples, the contribution to morphological diagnosis, and the possible use of samples for immunohistochemistry were analyzed.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">One hundred and twenty-nine samples corresponding to 110 patients were reviewed. The diagnosis was lung cancer in 81% of cases, extrapulmonary carcinoma in 10%, sarcoidosis in 4%, lymphoma in 2.7%, and tuberculosis in 0.9%. Cell blocks could be obtained in 72% of cases. Immunohistochemistry studies on the cell blocks were significantly easier to perform than on conventional smears (52.6% vs 14%, <span class="elsevierStyleItalic">P</span><.0001). In 4 cases, the cell block provided an exclusive morphological diagnosis (3 sarcoidosis and one metastasis from prostatic carcinoma) and in 3 carcinomas, subtype and origin could be identified. Exclusive diagnoses from the cell block were significantly more frequent in benign disease than in malignant disease (25% vs 0.9%, <span class="elsevierStyleItalic">P</span>=.002).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cell blocks were obtained from 72% of EBUS-TBNA diagnostic procedures. The main contributions of cell blocks to pathology examinations were the possibility of carrying out immunohistochemical staining for the better classification of neoplasms, especially extrapulmonary metastatic tumors, and the improved diagnosis of benign lesions.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La punción transbronquial guiada por ecoendoscopia permite obtener bloques celulares a partir del material de punción. Nuestro objetivo fue analizar su contribución al diagnóstico citológico convencional.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Metodología</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisión retrospectiva de las punciones por ecobroncoscopia realizadas de forma consecutiva durante 2 años con diagnóstico específico. Se analizó la capacidad de generar bloques celulares, su contribución al diagnóstico y a la realización de técnicas de inmunohistoquímica.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se revisaron 129 muestras de lesiones correspondientes a 110 pacientes. En el 91% el diagnóstico fue de malignidad. Las lesiones puncionadas más frecuentemente fueron las adenopatías 4R (28%) y subcarinal (21%). El 72% de las muestras se procesaron como bloque celular, siendo su capacidad para realizar técnicas de inmunohistoquímica significativamente mayor a la de las muestras citológicas (52,6% vs. 14%, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001). En 4 casos el bloque permitió un diagnóstico morfológico exclusivo (3 sarcoidosis y una metástasis de adenocarcinoma prostático) y en 3 carcinomas definir el subtipo y origen. El diagnóstico exclusivo mediante bloque celular fue significativamente más frecuente en la patología benigna que en la maligna (25% vs. 0,9%, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La obtención de bloque celular a partir de muestras de punción por ecobroncoscopia fue del 72%. Sus principales aportaciones fueron la mejora del diagnóstico de lesiones benignas y la capacidad para realizar técnicas de inmunohistoquímica cuya contribución es esencial para la tipificación de neoplasias.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lourido-Cebreiro T, Leiro-Fernández V, Tardio-Baiges A, Botana-Rial M, Núñez-Delgado M, Álvarez-Martín MJ, et al. Aportación del bloque celular en el diagnóstico de adenopatías y masas mediastínicas o hiliares realizado por ecobroncoscopia. Arch Bronconeumol. 2014;50:267–271.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3654 "Ancho" => 1603 "Tamanyo" => 402067 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Processing of samples. (A) <span class="elsevierStyleItalic">Cytological smear processing.</span> (A.1) Aspirated material discharged on a slide. (A.2) It is smeared with the aid of another slide and then left to dry. (A.3) Diff-Quick staining. (A.4) Rapid on-site evaluation. (A.5) Example of an epidermoid carcinoma cytology smear. (B) <span class="elsevierStyleItalic">Preparation of the cell block.</span> (B.1) Aspirate material containing bloody remains and tissue microfragments is left to clot. (B.2) The clot is fixed in formol. (B.3) It is then set in paraffin for processing as a biopsy specimen. (B.4) Slide with cell block specimen. (B.5) Microscopic image of an epidermoid carcinoma cell block.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">NOS: not otherwise specified.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Patients</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n=110 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex, males</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (75.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">EBUS-TBNA samples</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Lymphadenopathies</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">119 (92.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (27.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (21.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (8.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (7.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>11R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (4.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>12R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>11L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (19.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (3.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Masses</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (7.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Patient diagnosis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-small cell carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (70%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Small cell carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metastasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (10.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neuroendocrine carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NOS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (5.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tuberculosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab521245.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient Characteristics, Lesions Aspirated and Final Diagnosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive endoscopic staging of suspected lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Wallace" 1 => "J.M.S. Pascual" 2 => "M. Raimondo" 3 => "T.A. Wodward" 4 => "B.L. McComb" 5 => "J.E. Crook" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.299.5.540" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "299" "paginaInicial" => "540" "paginaFinal" => "546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18252884" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness and safety of endobronchial ultrasound–transbronchial needle aspiration: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Varela-Lema" 1 => "A. Fernández-Villar" 2 => "A. Ruano-Ravina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00097908" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2009" "volumen" => "33" "paginaInicial" => "1156" "paginaFinal" => "1164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19407050" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Anantham" 1 => "M. Siyue Koh" 2 => "A. Ernst" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2009.04.010" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2009" "volumen" => "103" "paginaInicial" => "1406" "paginaFinal" => "1414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19447014" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.A. Silvestri" 1 => "A.V. Gonzalez" 2 => "M.A. Jantz" 3 => "M.L. Margolis" 4 => "M.K. Gould" 5 => "L.T. Tanoue" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "2013" "volumen" => "143" "numero" => "Suppl." "paginaInicial" => "211S" "paginaFinal" => "250S" "itemHostRev" => array:3 [ "pii" => "S0001731011002134" "estado" => "S300" "issn" => "00017310" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.T. Annema" 1 => "J.P. van Meerbeeck" 2 => "R.C. Rintoul" 3 => "C. Dooms" 4 => "E. Deschepper" 5 => "O.M. Dekkers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2010.1705" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2010" "volumen" => "304" "paginaInicial" => "2245" "paginaFinal" => "2252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21098770" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement of cellularity on cell block preparations using the so-called tissue coagulum clot method during endobronchial ultrasound-guided transbronchial fine-needle aspiration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.C. Yung" 1 => "S. Otell" 2 => "P. Illei" 3 => "D.P. Clark" 4 => "D. Feller-Kopman" 5 => "L. Yarmus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncy.20199" "Revista" => array:6 [ "tituloSerie" => "Cancer Cytopathol" "fecha" => "2012" "volumen" => "120" "paginaInicial" => "185" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22144401" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytology of endobronchial ultrasound-guided transbronchial needle aspiration versus conventional transbronchial needle aspiration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.M. Stoll" 1 => "R.C.W. Yong" 2 => "D.P. Clark" 3 => "Q.K. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncy.20103" "Revista" => array:6 [ "tituloSerie" => "Cancer Cytopathol" "fecha" => "2010" "volumen" => "118" "paginaInicial" => "278" "paginaFinal" => "286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20740503" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Natu" 1 => "J. Hoffman" 2 => "M. Siddiqui" 3 => "C. Hobday" 4 => "J. Shrimankar" 5 => "R. Harrison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/jcp.2009.074328" "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "445" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20299387" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic ultrasound guided transbronchial fine needle aspiration: a French Department of Pathology's 4-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Delattre" 1 => "C. Fournier" 2 => "B. Bouchindhomme" 3 => "F. Renaud" 4 => "F. Escande" 5 => "P. Ramon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/jclinpath-2011-200382" "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "2011" "volumen" => "64" "paginaInicial" => "1117" "paginaFinal" => "1122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21965831" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cell block cytology: improved preparation and its efficacy in diagnostic cytology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.N. Nathan" 1 => "E. Narayan" 2 => "M.T. Smith" 3 => "M.J. Horn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1309/G035-P2MM-D1TM-T5QE" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "2000" "volumen" => "114" "paginaInicial" => "599" "paginaFinal" => "606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11026107" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contribution of cell blocks obtained through endobronchial ultrasound-guided transbronchial needle aspiration to the diagnosis of lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Sanz-Santos" 1 => "P. Serra" 2 => "F. Andreo" 3 => "M. Llatjós" 4 => "E. Castellà" 5 => "E. Monsó" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMC Cancer" "fecha" => "2012" "volumen" => "21" "paginaInicial" => "12" "paginaFinal" => "34" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EBUS-TBNA learning curve for mediastinal and hilar lymph node diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Fernández-Villar" 1 => "V. Leiro-Fernández" 2 => "M.I. Botana" 3 => "C. Represas" 4 => "M. Nunez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-1986" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "141" "paginaInicial" => "278" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22215843" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A acquisition and processing of endobronchial ultrasound-guided transbronchial needle aspiration specimens in the era of targeted lung cancer chemotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Bulman" 1 => "A. Saqi" 2 => "C. Powell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201107-1199CI" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2012" "volumen" => "185" "paginaInicial" => "606" "paginaFinal" => "611" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22071327" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0190962213007779" "estado" => "S300" "issn" => "01909622" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Oki" 1 => "H. Saka" 2 => "C. Kitagawa" 3 => "Y. Kogure" 4 => "N. Murata" 5 => "T. Adachi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000346987" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2013" "volumen" => "85" "paginaInicial" => "486" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23571718" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fine needle aspiration cytology: experience with a cell block technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.D. Burt" 1 => "D. Smillie" 2 => "M.D. Cowan" 3 => "F.G. Adams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "1986" "volumen" => "39" "paginaInicial" => "114" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16811161" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are EUS-FNA and EBUS-TBNA specimens reliable for subtyping non-small cell lung cancer?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.G. Tournoy" 1 => "M. Carprieaux" 2 => "E. Deschepper" 3 => "J.P. van Meerbeeck" 4 => "M. Praet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lungcan.2011.09.004" "Revista" => array:6 [ "tituloSerie" => "Lung Cancer" "fecha" => "2012" "volumen" => "76" "paginaInicial" => "46" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21945658" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of cell typing in non-small cell lung cancer by EBUS/EUS-TBNA citology samples" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Wallace" 1 => "D.M. Rassl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00176410" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2011" "volumen" => "38" "paginaInicial" => "911" "paginaFinal" => "917" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21406513" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A combination of smears and cell block preparations provides high diagnostic accuracy for endobronchial ultrasound-guided transbronchial needle aspiration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Gauchotte" 1 => "J.-M. Vignaud" 2 => "O. Ménard" 3 => "M.P. Wissler" 4 => "Y. Martinet" 5 => "J. Siat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00428-012-1296-x" "Revista" => array:6 [ "tituloSerie" => "Virchows Arch" "fecha" => "2012" "volumen" => "461" "paginaInicial" => "505" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22895864" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The combination of cytological smears and cell blocks on endobronchial ultrasound-guided transbronchial needle aspirates allows a higher diagnostic yield" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.O. Alici" 1 => "N.Y. Demirci" 2 => "A. Yılmaz" 3 => "F. Demirag" 4 => "J. Karakaya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00428-013-1374-8" "Revista" => array:6 [ "tituloSerie" => "Virchows Arch" "fecha" => "2013" "volumen" => "462" "paginaInicial" => "323" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23377781" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.B. Von Bartheld" 1 => "M. Veseliç-Charvat" 2 => "K.F. Rabe" 3 => "J.T. Annema" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0029-1243890" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2010" "volumen" => "42" "paginaInicial" => "213" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20195990" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The yield of endoscopic ultrasound-guided fine needle aspiration for histological diagnosis in patients suspected of stage <span class="elsevierStyleSmallCaps">i</span> sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Iwashita" 1 => "I. Yasuda" 2 => "S. Doi" 3 => "T. Kato" 4 => "K. Sano" 5 => "S. Yasuda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Endoscopy" "fecha" => "2008" "volumen" => "405" "paginaInicial" => "400" "paginaFinal" => "405" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytologic assessment of endobronchial ultrasound-guided transbronchial needle aspirates in sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Chee" 1 => "M. Khalil" 2 => "D.R. Stather" 3 => "P. MacEachern" 4 => "S.K. Campo" 5 => "A. Tremblay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bronchology Interv Pulmonol" "fecha" => "2012" "volumen" => "1" "paginaInicial" => "24" "paginaFinal" => "28" "itemHostRev" => array:3 [ "pii" => "S0001731012003092" "estado" => "S300" "issn" => "00017310" ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cell block interpretation is helpful in the diagnosis of granulomas on cytology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.E. Schwartz" 1 => "A.C. Griffin" 2 => "Z. Baloch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/dc.21761" "Revista" => array:6 [ "tituloSerie" => "Diagn Cytopathol" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "939" "paginaFinal" => "940" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21710647" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Navani" 1 => "P.L. Molyneaux" 2 => "R.A. Breen" 3 => "D.W. Connell" 4 => "A. Jepson" 5 => "M. Nankivell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thoraxjnl-2011-200063" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2011" "volumen" => "66" "paginaInicial" => "889" "paginaFinal" => "893" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21813622" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgements" "texto" => "<p id="par0115" class="elsevierStylePara elsevierViewall">The specimens used belong to the CHUVI Biobank (RETIC-FIS-ISCIII RD09/0076/00011).</p> <p id="par0120" class="elsevierStylePara elsevierViewall">EU Seventh Framework Program (FP7/REGPOT-2012-2013-1; Code: No. 316265, BIOCAPS).</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000007/v1_201406290026/S1579212914001426/v1_201406290026/en/main.assets" "Apartado" => array:4 [ "identificador" => "9374" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000007/v1_201406290026/S1579212914001426/v1_201406290026/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001426?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 59 | 18 | 77 |
| 2024 September | 50 | 20 | 70 |
| 2024 August | 47 | 44 | 91 |
| 2024 July | 40 | 26 | 66 |
| 2024 June | 53 | 31 | 84 |
| 2024 May | 83 | 30 | 113 |
| 2024 April | 51 | 21 | 72 |
| 2024 March | 49 | 14 | 63 |
| 2024 February | 37 | 24 | 61 |
| 2023 March | 13 | 6 | 19 |
| 2023 February | 53 | 29 | 82 |
| 2023 January | 37 | 31 | 68 |
| 2022 December | 46 | 38 | 84 |
| 2022 November | 85 | 50 | 135 |
| 2022 October | 73 | 42 | 115 |
| 2022 September | 71 | 37 | 108 |
| 2022 August | 71 | 52 | 123 |
| 2022 July | 91 | 37 | 128 |
| 2022 June | 72 | 33 | 105 |
| 2022 May | 81 | 46 | 127 |
| 2022 April | 52 | 32 | 84 |
| 2022 March | 70 | 54 | 124 |
| 2022 February | 78 | 43 | 121 |
| 2022 January | 97 | 33 | 130 |
| 2021 December | 76 | 37 | 113 |
| 2021 November | 74 | 50 | 124 |
| 2021 October | 67 | 47 | 114 |
| 2021 September | 46 | 48 | 94 |
| 2021 August | 42 | 43 | 85 |
| 2021 July | 39 | 31 | 70 |
| 2021 June | 63 | 54 | 117 |
| 2021 May | 56 | 30 | 86 |
| 2021 April | 100 | 80 | 180 |
| 2021 March | 57 | 27 | 84 |
| 2021 February | 41 | 22 | 63 |
| 2021 January | 39 | 27 | 66 |
| 2020 December | 49 | 35 | 84 |
| 2020 November | 29 | 21 | 50 |
| 2020 October | 32 | 22 | 54 |
| 2020 September | 19 | 10 | 29 |
| 2020 August | 38 | 17 | 55 |
| 2020 July | 29 | 25 | 54 |
| 2020 June | 19 | 5 | 24 |
| 2020 May | 37 | 15 | 52 |
| 2020 April | 45 | 26 | 71 |
| 2020 March | 35 | 15 | 50 |
| 2020 February | 37 | 17 | 54 |
| 2020 January | 32 | 16 | 48 |
| 2019 December | 46 | 14 | 60 |
| 2019 November | 34 | 16 | 50 |
| 2019 October | 29 | 14 | 43 |
| 2019 September | 21 | 9 | 30 |
| 2019 August | 37 | 17 | 54 |
| 2019 July | 38 | 17 | 55 |
| 2019 June | 37 | 18 | 55 |
| 2019 May | 50 | 33 | 83 |
| 2019 April | 53 | 53 | 106 |
| 2019 March | 62 | 19 | 81 |
| 2019 February | 45 | 18 | 63 |
| 2019 January | 42 | 22 | 64 |
| 2018 December | 41 | 15 | 56 |
| 2018 November | 80 | 27 | 107 |
| 2018 October | 125 | 31 | 156 |
| 2018 September | 27 | 10 | 37 |
| 2018 May | 20 | 0 | 20 |
| 2018 April | 38 | 6 | 44 |
| 2018 March | 21 | 0 | 21 |
| 2018 February | 26 | 12 | 38 |
| 2018 January | 26 | 7 | 33 |
| 2017 December | 26 | 8 | 34 |
| 2017 November | 41 | 8 | 49 |
| 2017 October | 29 | 11 | 40 |
| 2017 September | 45 | 4 | 49 |
| 2017 August | 83 | 15 | 98 |
| 2017 July | 58 | 4 | 62 |
| 2017 June | 95 | 8 | 103 |
| 2017 May | 97 | 13 | 110 |
| 2017 April | 72 | 4 | 76 |
| 2017 March | 60 | 6 | 66 |
| 2017 February | 44 | 14 | 58 |
| 2017 January | 24 | 3 | 27 |
| 2016 December | 37 | 7 | 44 |
| 2016 November | 58 | 9 | 67 |
| 2016 October | 74 | 23 | 97 |
| 2016 September | 76 | 17 | 93 |
| 2016 August | 69 | 13 | 82 |
| 2016 July | 41 | 8 | 49 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 3 | 0 | 3 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 56 | 4 | 60 |
| 2015 September | 62 | 16 | 78 |
| 2015 August | 66 | 24 | 90 |
| 2015 July | 53 | 10 | 63 |
| 2015 June | 42 | 12 | 54 |
| 2015 May | 50 | 16 | 66 |
| 2015 April | 38 | 20 | 58 |
| 2015 March | 46 | 13 | 59 |
| 2015 February | 47 | 8 | 55 |
| 2015 January | 35 | 8 | 43 |
| 2014 December | 39 | 9 | 48 |
| 2014 November | 41 | 17 | 58 |
| 2014 October | 43 | 24 | 67 |
| 2014 September | 1 | 0 | 1 |
| 2014 August | 0 | 2 | 2 |
| 2014 July | 1 | 0 | 1 |
Show all
