Related Articles

Specimen Processing Techniques for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration.

Ann Thorac Surg. 2013 Jan 24;

Authors: Toth JW, Zubelevitskiy K, Strow JA, Kaifi JT, Kunselman AR, Reed MF

Abstract
BACKGROUND: Endobronchial ultrasound is used for sampling thoracic pathologic processes. Histologic examination may provide added diagnostic yield to cytologic preparations owing to superior assessment of architecture and immunohistochemistry. It remains unclear whether specific specimen processing technique impacts diagnostic yield. We hypothesized that diagnostic yield using histologic analysis of core needle biopsies is higher than cytologic preparations alone. METHODS: We evaluated 177 consecutive patients with mediastinal abnormalities. An interventional pulmonologist or thoracic surgeon performed endobronchial ultrasound. We compared diagnostic yields of two specimen processing techniques, fixed slides (cytology) and formalin-fixed core samples (histology). Results were categorized as malignant, benign (infectious, inflammatory), normal nodal tissue, or inadequate sampling (nondiagnostic). Malignancy, a defined benign process, and normal lymph node were considered diagnostic. RESULTS: The diagnostic yield for benign processes was higher by histologic examination (n = 37) than in cytologic preparations (n = 22; p = 0.0064). The diagnostic yield was comparable in malignancy (p = 0.7530). The combination of both techniques provided a higher overall diagnostic rate: 84% (n = 148) by histology, 82% (n = 146) by cytology, and 89% (n = 158) using both. Using two techniques revealed discordance in 23% (n = 40), demonstrating that the use of one technique alone would have resulted in missed diagnoses. CONCLUSIONS: Adding histologic analysis of tissue cores obtained by endobronchial ultrasound offers higher diagnostic accuracy than only cytologic preparation of needle aspirates. Histologic and cytologic methods offer comparable diagnostic rates for malignancy. However, diagnostic yield for benign conditions is higher using histologic examination. Together, histology and cytology provide fewer missed diagnoses than either individually. When using endobronchial ultrasound, it is ideal to routinely use both needle aspirate cytology and core biopsy histology.

PMID: 23352297 [PubMed - as supplied by publisher]

Related Articles

Clot resolution after 3 weeks of anticoagulant treatment of pulmonary embolism: comparison of computed tomography and perfusion scintigraphy.

J Thromb Haemost. 2013 Jan 24;

Authors: van Es J, Douma RA, Kamphuisen PW, Gerdes VE, Verhamme P, Wells PS, Bounameaux H, Lensing AW, Büller HR

Abstract
INTRODUCTION: Little is known about the natural history of clot resolution in the initial weeks of anticoagulant therapy in patients with acute pulmonary embolism (PE). Clot resolution of acute pulmonary embolism (PE) was assessed with either computed tomography pulmonary angiography (CT-scan) or perfusion scintigraphy (Q-scan) after 3 weeks of treatment. METHODS: This was a predefined safety analysis of the Einstein PE study, including PE patients, randomized to either enoxaparin with vitamin K antagonists or rivaroxaban. A similar scan as at baseline was repeated after 3 weeks. The percentage of pulmonary vascular obstruction (PVO) was calculated based on a weighted semi-quantitative estimation of obstruction. Clot resolution was assessed blindly by calculating the relative change after 3 weeks. RESULTS: PE was diagnosed in 264 patients with CT-scan and in 83 with Q-scan. Baseline characteristics were comparable. At baseline, the mean PVO assessed with CT-scan (PVO-CT) and with Q-scan (PVO-Q) were both 21% (Standard deviation (SD) 13%) (p = 0.9). The mean relative decrease in PVO was 71% (SD) 33%) for PVO-CT, compared to 62% (SD 36%) for PVO-Q (p=0.02), while complete resolution was observed in 44% (116/264; 95% CI 38-50%) and 31% (26/83; 95% CI 22-42%) with of CT-scan and Q-scan, respectively (p=0.04). No difference in clot resolution between enoxaparin/VKA and rivaroxaban was found. CONCLUSION: In patients with acute PE, only 3 weeks of anticoagulant treatment leads to complete clot resolution in a considerable proportion of patients and normalization is more often observed with CT-scan than with Q-scan. © 2013 International Society on Thrombosis and Haemostasis.

PMID: 23347140 [PubMed - as supplied by publisher]

Symptoms and clinical relevance: A dilemma for clinical trials on prevention of venous thromboembolism.

Thromb Haemost. 2013 Jan 24;109(4)

Authors: Bounameaux H, Agnelli G

Abstract
The outcomes of thromboprophylactic trials have been debated for decades. Recently, the 9 th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines based their strong recommendations only on patient-important outcomes. Practically, symptoms were considered the crucial element. Consequently, studies that primarily aimed at reducing venographic thrombi were considered less pertinent than studies that focused on symptomatic thrombosis. In the present viewpoint, we challenge the argument that "symptomatic" and "clinically relevant" are interchangeable. In particular, the case is made that asymptomatic events may be clinically relevant and that asymptomatic venographically detected thrombosis is a clinically relevant surrogate outcome for fatal pulmonary embolism.

PMID: 23348892 [PubMed - as supplied by publisher]

3D contrast-enhanced lung perfusion MRI is an effective screening tool for chronic thromboembolic pulmonary hypertension: results from the ASPIRE Registry.

Thorax. 2013 Jan 24;

Authors: Rajaram S, Swift AJ, Telfer A, Hurdman J, Marshall H, Lorenz E, Capener D, Davies C, Hill C, Elliot C, Condliffe R, Wild JM, Kiely DG

Abstract
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism potentially curable by surgery. Perfusion scintigraphy is currently advocated as the imaging modality of choice to exclude CTEPH due to its high sensitivity. We have evaluated the diagnostic utility of lung perfusion MRI. METHODS: Consecutive patients attending a pulmonary hypertension referral centre undergoing lung perfusion MRI, perfusion scintigraphy, CT pulmonary angiography (CTPA) and right heart catheterisation within 14 days were identified. RESULTS: Of 132 patients, 78 were diagnosed as having CTEPH. Lung perfusion MRI correctly identified 76 patients as having CTEPH with an overall sensitivity of 97%, specificity 92%, positive predictive value 95% and negative predictive value 96% compared with perfusion scintigraphy (sensitivity 96%, specificity 90%) and CTPA (sensitivity 94%, specificity 98%). No cases of surgically accessible CTEPH were missed with either modality. CONCLUSIONS: Lung perfusion MRI has high sensitivity equivalent to perfusion scintigraphy in diagnosing CTEPH but does not require ionising radiation, making it an attractive initial imaging modality to assess patients with suspected CTEPH.

PMID: 23349220 [PubMed - as supplied by publisher]