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Open Access Research article

Contribution of cell blocks obtained through endobronchial ultrasound-guided transbronchial needle aspiration to the diagnosis of lung cancer

José Sanz-Santos13*, Pere Serra1, Felipe Andreo14, Maria Llatjós24, Eva Castellà24 and Eduard Monsó45

Author Affiliations

1 Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet S/N, 08916 Badalona, Barcelona, Spain

2 Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

3 Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain

4 CIBER de Enfermedades Respiratorias (CibeRes), Bunyola, Balearic Islands, Spain

5 Pulmonology Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain

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BMC Cancer 2012, 12:34  doi:10.1186/1471-2407-12-34

Published: 21 January 2012

Abstract

Background

Conventional smears of samples obtained by endobronchial ultrasound with real-time transbronchial needle aspiration (EBUS-TBNA) have proven useful in lung cancer staging, but the value of additional information from cell-block processing of EBUS-TBNA samples has only been marginally investigated. This study focussed on the contribution of cell block analysis to the diagnostic yield in lung cancer.

Methods

Patients referred for lung cancer diagnosis and/or staging by means of EBUS-TBNA were enrolled, the adequacy of the obtained samples for preparing cell blocks was assessed, and the additional pathologic or genetic information provided from cell block analysis was examined.

Results

In 270 lung cancer patients referred for EBUS-TBNA (mean age, 63.3 SD 10.4 years) 697 aspirations were performed. Cell blocks could be obtained from 334 aspirates (47.9%) and contained diagnostic material in 262 (37.6%) aspirates, providing information that was additional to conventional smears in 50 of the 189 samples with smears that were non-diagnostic, corresponding 21 of these blocks to malignant nodes, and allowing lung cancer subtyping of 4 samples. Overall, cell blocks improved the pathologic diagnosis attained with conventional smears in 54 of the 697 samples obtained with EBUS-TBNA (7.7%). Cell blocks obtained during EBUS-TBNA also made epithelial growth factor receptor mutation analysis possible in 39 of the 64 patients with TBNA samples showing metastatic adenocarcinoma (60.1%). Overall, cell blocks provided clinically significant information for 83 of the 270 patients participating in the study (30.7%).

Conclusions

Cell-block preparation from EBUS-TBNA samples is a simple way to provide additional information in lung cancer diagnosis. Analysis of cell blocks increases the diagnostic yield of the procedure by nearly seven per cent and allows for genetic analysis in a sixty per cent of the patients with metastatic adenocarcinoma.

Keywords:
Cell block; Endobronchial ultrasound; Transbronchial needle aspiration; Lung cancer