Controversy On-site Cytopathologic Analysis of Bronchoscopic Needle Aspiration Pro: On-site Analysis Is Indicated

摘要

Bronchoscopic needle aspiration (BNA) is a valuable diagnostic and staging tool in intrathoracic malignancies and other mediastinal diseases but is underused. Impediments to its popular use include lack of formal training, technical problems with the procedure, unavailability of expert cytopathologists, concerns of false-positive results, failure to reproduce published results, risk of damage to the bronchoscope, concerns regarding the safety of the procedure, and reservations regarding the clinical utility of BNA. Some of these problems may be able to be overcome with the use of on-site cytopathologic review. It has been documented that training can improve diagnostic yield, but to maintain proficiency continuous feedback is invaluable. Immediate feedback from on-site review can help improve technique and needle positioning. False positives can be reduced by enhanced communication with the cytopathologists as well as independent review of the slides. The presence of lymphocytes mixed with malignant cells or large clumps of malignant cells helps determine proper acquisition of metastatic deposits and excludes the specimen with rare cells, which may indicate endobronchial contamination. Inadequate specimens with the presence of numerous bronchial epithelial cells without lymphocytes or malignant cells can help decision making during the procedure: either to redirect the needle or to proceed with other diagnostic techniques if further needle aspiration is felt to be futile. The use of rapid on-site evaluation (ROSE) in training can be amply demonstrated in the education of pulmonary fellows in the technique. The visual feedback that they can see in review of slides soon after the performance of the procedure can boost their confidence in the proper technique and can reinforce it as well as allow them to see the "disappointing" results of improper sampling.