Skip to main content

Advertisement

SpringerLink
Log in

Atypical cells in pathology of endobronchial ultrasound-guided transbronchial biopsy of peripheral pulmonary lesions: incidence and clinical significance

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Atypical cells may occasionally be the only pathologic finding in radial-probe endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) of peripheral pulmonary lesions (PPLs); however, it is uncertain how often we encounter such a situation and what clinical features can be used to identify these ambiguous PPLs, which are more likely to be malignant.

Methods

From 2009 to 2016, consecutive patients referred for EBUS-guided TBB of PPLs and with pathology reports indicating atypical cells alone were included. Medical records were reviewed to extract patient demographics, clinical characteristics, procedural details and complications. The primary outcome was the final diagnosis of the PPLs on subsequent investigation. Multivariate logistic regression analysis was used to identify independent factors associated with a final malignant diagnosis.

Results

One hundred sixty-five (7.2%) of 2291 patients had non-diagnostic TBB showing atypical cells. Benign and malignant diagnoses were subsequently obtained in 45 (27%) and 120 (73%) patients, respectively. The leading malignancy was lung adenocarcinoma; of note, a variety of benign lesions revealed cellular atypia on pathology, in particular, chronic inflammation, tuberculosis and pneumonia. Multivariate analysis indicated lesion appearance [solid vs. others; odds ratio (OR) 7.93; 95% confidence interval (CI) 2.94–21.40; P < 0.001] and probe position (adjacent to vs. within; OR 3.36; 95% CI 1.11–10.15; P = 0.032) were two significant factors predictive of a final diagnosis of malignancy.

Conclusions

One out of 14 EBUS-guided TBB procedures for PPLs exhibited atypical cells on pathology. Meticulous management strategies should be formulated to deal with these instances after taking into consideration lesion appearance, probe position and patient preferences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS (2013) Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e93S–e120S

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rivera MP, Mehta AC, Wahidi MM (2013) 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 143(5 Suppl):e142S–e165S

    Article  Google Scholar 

  3. Paone G, Nicastri E, Lucantoni G, Dello Iacono R, Battistoni P, D’Angeli AL, Galluccio G (2005) Endobronchial ultrasound-driven biopsy in the diagnosis of peripheral lung lesions. Chest 128(5):3551–3557

    Article  PubMed  Google Scholar 

  4. Herth FJ, Eberhardt R, Becker HD, Ernst A (2006) Endobronchial ultrasound-guided transbronchial lung biopsy in fluoroscopically invisible solitary pulmonary nodules: a prospective trial. Chest 129(1):147–150

    Article  CAS  PubMed  Google Scholar 

  5. Oki M, Saka H, Ando M, Asano F, Kurimoto N, Morita K, Kitagawa C, Kogure Y, Miyazawa T (2015) Ultrathin Bronchoscopy with Multimodal Devices for Peripheral Pulmonary Lesions. A Randomized Trial. Am J Respir Crit Care Med 192(4):468–476

    Article  PubMed  Google Scholar 

  6. 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 YMRM, Rafeq S, Grosu HB, Ray C, Gilbert CR, Yarmus LB, Simoff M, Registry AQB (2016) Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med 193(1):68–77

    Article  PubMed  PubMed Central  Google Scholar 

  7. Steinfort DP, Khor YH, Manser RL, Irving LB (2011) Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 37(4):902–910

    Article  CAS  PubMed  Google Scholar 

  8. Wang Memoli JS, Nietert PJ, Silvestri GA (2012) Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest 142(2):385–393

    Article  PubMed  Google Scholar 

  9. Schuhmann M, Eberhardt R, Herth FJ (2013) Endobronchial ultrasound for peripheral lesions: a review. Endosc Ultrasound 2(1):3–6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Min JW, Lee SM, Chung DH, Yim JJ, Yang SC, Yoo CG, Kim YW, Han SK, Shim YS, Chung HS (2009) Clinical significance of non-diagnostic pathology results from percutaneous transthoracic needle lung biopsy: experience of a tertiary hospital without an on-site cytopathologist. Respirology 14(7):1042–1050

    Article  PubMed  Google Scholar 

  11. Huang CT, Ruan SY, Liao WY, Kuo YW, Lin CY, Tsai YJ, Ho CC, Yu CJ (2012) Risk factors of pneumothorax after endobronchial ultrasound-guided transbronchial biopsy for peripheral lung lesions. PLoS ONE 7(11):e49125

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Huang CT, Ruan SY, Tsai YJ, Ho CC, Yu CJ (2017) Experience improves the performance of endobronchial ultrasound-guided transbronchial biopsy for peripheral pulmonary lesions: a learning curve at a medical centre. PLoS ONE 12(6):e0179719

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Huang CT, Tsai YJ, Liao WY, Wu PC, Ho CC, Yu CJ, Yang PC (2012) Endobronchial ultrasound-guided transbronchial biopsy of peripheral pulmonary lesions: how many specimens are necessary? Respiration 84(2):128–134

    Article  PubMed  Google Scholar 

  14. Huang CT, Ho CC, Tsai YJ, Yu CJ, Yang PC (2009) Factors influencing visibility and diagnostic yield of transbronchial biopsy using endobronchial ultrasound in peripheral pulmonary lesions. Respirology 14(6):859–864

    Article  PubMed  Google Scholar 

  15. Huang CT, Tsai YJ, Ho CC, Yu CJ (2017) The value of repeat radial-probe endobronchial ultrasound-guided transbronchial biopsy after initial non-diagnostic results in patients with peripheral pulmonary lesions. BMC Pulm Med 17(1):132

    Article  PubMed  PubMed Central  Google Scholar 

  16. Curley FJ, Johal JS, Burke ME, Fraire AE (1998) Transbronchial lung biopsy: can specimen quality be predicted at the time of biopsy? Chest 113(4):1037–1041

    Article  CAS  Google Scholar 

  17. Yoshikawa M, Sukoh N, Yamazaki K, Kanazawa K, Fukumoto S, Harada M, Kikuchi E, Munakata M, Nishimura M, Isobe H (2007) Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without X-ray fluoroscopy. Chest 131(6):1788–1793

    Article  PubMed  Google Scholar 

  18. Yamada N, Yamazaki K, Kurimoto N, Asahina H, Kikuchi E, Shinagawa N, Oizumi S, Nishimura M (2007) Factors related to diagnostic yield of transbronchial biopsy using endobronchial ultrasonography with a guide sheath in small peripheral pulmonary lesions. Chest 132(2):603–608

    Article  PubMed  Google Scholar 

  19. Eberhardt R, Ernst A, Herth FJ (2009) Ultrasound-guided transbronchial biopsy of solitary pulmonary nodules less than 20 mm. Eur Respir J 34(6):1284–1287

    Article  CAS  PubMed  Google Scholar 

  20. Travis WD (2011) Pathology of lung cancer. Clin Chest Med 32(4):669–692

    Article  PubMed  Google Scholar 

  21. Leslie KO (2004) Pathology of interstitial lung disease. Clin Chest Med 25(4):657–703

    Article  PubMed  Google Scholar 

  22. Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, Protzko S, Raghu G, Richeldi L, Sverzellati N, Swigris J, Valeyre D, Pneumonias AECoII (2013) An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188(6):733–748

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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 (2013) 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 137(5):668–684

    Article  PubMed  Google Scholar 

  24. Auger M, Moriarty AT, Laucirica R, Souers R, Chmara BA, Fatheree LA, Wilbur DC (2010) Granulomatous inflammation-an underestimated cause of false-positive diagnoses in lung fine-needle aspirates: observations from the College of American Pathologists Nongynecologic Cytopathology Interlaboratory Comparison Program. Arch Pathol Lab Med 134(12):1793–1796

    PubMed  Google Scholar 

  25. Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS, Group E (2002) CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 178(5):1053–1057

    Article  Google Scholar 

  26. Kurimoto N, Miyazawa T, Okimasa S, Maeda A, Oiwa H, Miyazu Y, Murayama M (2004) Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. Chest 126(3):959–965

    Article  PubMed  Google Scholar 

  27. Chung YH, Lie CH, Chao TY, Wang YH, Lin AS, Wang JL, Lin MC (2007) Endobronchial ultrasonography with distance for peripheral pulmonary lesions. Respir Med 101(4):738–745

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the staff of the Eighth Core Lab, Department of Medical Research, National Taiwan University Hospital, for technical support during the study.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, 100, Taiwan, Republic of China

    Chun-Ta Huang, Chao-Chi Ho & Chong-Jen Yu

  2. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China

    Chun-Ta Huang

  3. Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, Republic of China

    Yi-Ju Tsai

Authors
  1. Chun-Ta Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi-Ju Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chao-Chi Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chong-Jen Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chao-Chi Ho.

Ethics declarations

Disclosures

Drs. Chun-Ta Huang, Yi-Tu Tsai, Chao-Chi Ho, and Chong-Jen Yu have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, CT., Tsai, YJ., Ho, CC. et al. Atypical cells in pathology of endobronchial ultrasound-guided transbronchial biopsy of peripheral pulmonary lesions: incidence and clinical significance. Surg Endosc 33, 1783–1788 (2019). https://doi.org/10.1007/s00464-018-6452-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6452-1

Keywords

Search

Navigation