Significance of the Presence of Lymphocytes in the Cytological Analysis of Transbronchial Needle Aspiration

Lucena, Carmen M.; Agustí, Carles; Martínez-Olondris, Pilar; Cano-Jiménez, Esteban; Marrades, Ramón M.; Ramírez, Josep; Sánchez, Marcelo; Arguis, Pedro; Xaubet, Antoni

doi:10.1016/S1579-2129(11)70030-1

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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Vol. 47. Issue 3.

Pages 122-127 (January 2011)

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Pages 122-127 (January 2011)

Original Article

DOI: 10.1016/S1579-2129(11)70030-1

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Significance of the Presence of Lymphocytes in the Cytological Analysis of Transbronchial Needle Aspiration

Significado de la presencia de linfocitos en el análisis citológico de la punción transbronquial aspirativa

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Carmen M. Lucenaa,

Corresponding author

cmlucena@clinic.ub.es

Corresponding author.

, Carles Agustía, Pilar Martínez-Olondrisa, Esteban Cano-Jiméneza, Ramón M. Marradesa, Josep Ramírezb, Marcelo Sánchezc, Pedro Arguisc, Antoni Xaubeta

a Servicio de Neumología, Instituto Clínico del Tórax, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes) 2009 SGR 911, Barcelona, Spain

b Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, Spain

c Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, Spain

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Abstract

Aim

To evaluate the clinical relevance of the presence of lymphocytes in transbronchial needle aspiration (TBNA) samples from pathological mediastinal lymph nodes in patients with suspected lung cancer.

Methods

Retrospective observational study evaluating the negative predictive value (NPV) of TBNA samples with evidence of lymphocytes but no atypical cells.

Results

A total of 266 TBNA were performed in 252 patients with pathological mediastinal lymphadenopathy. One hundred and fifteen TBNA samples showed evidence of malignant cells (43%) and 94 (35%) samples were considered inadequate (absence of adequate cytological material or exclusive presence of bronchial epithelial cells). Out of the 57 TBNA samples remaining that contained lymphocytes without atypia (21%), 15 could not be confirmed. Thirty-two TBNA samples were confirmed with alternative diagnostic techniques and 10 were confirmed after clinical and radiological follow-up. The NPV of the 32 samples that were confirmed with alternative diagnostic techniques was 84%, which decreased to 76% when we included the 10 TBNA samples confirmed after clinical and radiological follow-up.

Conclusions

The presence of lymphocytes without atypia in TBNA samples does not rule out the neoplastic invasion of the lymph node analyzed.

Keywords:

Transbronchial needle aspiration

Lung cancer

Mediastinal lymphadenopathy

Resumen

Objetivo

Analizar el significado de la presencia de linfocitos en las muestras de punción transbronquial aspirativa (PTA) de adenopatías mediastínicas (AM) en pacientes con sospecha de cáncer de pulmón (CP).

Métodos

Estudio observacional retrospectivo que evalúa el valor predictivo negativo (VPN) de las muestras de PTA con evidencia de linfocitos pero sin células atípicas.

Resultados

Se realizaron 266 PTA a 252 pacientes con AM patológicas. En 115 PTA se evidenció la presencia de metástasis ganglionares (43%), y 94 (35%) fueron consideradas como no valorables (ausencia de material citológico evaluable o presencia exclusiva de células epiteliales bronquiales). De las 57 muestras de PTA restantes que contenían linfocitos sin atipias (21%), en 15 no se pudo confirmar el diagnóstico; en 32 se confirmó mediante técnicas diagnósticas alternativas y en 10 mediante seguimiento clínico-radiológico. El VPN de las 32 muestras confirmadas con técnicas diagnósticas alternativas fue del 84% y descendió al 76% cuando se incluyeron las 10 PTA en las que se disponía de seguimiento clínico-radiológico.

Conclusiones

La presencia de linfocitos sin atipias en la muestra de PTA no excluye la invasión neoplásica del ganglio analizado.

Palabras clave:

Punción transbronquial aspirativa

Cáncer de pulmón

Adenopatías mediastínicas

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