Diagnostic value of histology compared with cytology in transbronchial aspiration samples obtained by histology needle.

Objective: Results from endoscopic needle aspiration [transbronchial needle aspiration (TBNA), esophageal ultrasound-guided fine needle aspiration, real-time endobronchial ultrasound] mainly rely on cytology. We performed a retrospective study to evaluate the possible advantage of obtaining histologic samples during TBNA in the diagnostic assessment of mediastinal lymph node enlargement. Materials and Methods: In a retrospective study 2 pathologists evaluated all TBNAs from patients with mediastinal lymph node enlargement in whom representative histologic and cytologic material was obtained, using only a histology needle. Cytology was reviewed before histology in a randomized, blinded fashion. Afterward, the results were related to the diagnosis made in the actual workup of the patient. Results: A total of 50 TBNAs were reviewed. In 86% (43 of 50), both pathologists made the same diagnosis on both specimens, or a difference in cytology and/or histology specimens did not alter the eventual treatment. In 14% (7 of 50) of all TBNAs, histology revealed a diagnosis according to at least 1 pathologist, which altered patient treatment. Conclusions: Histologic material can reveal additional diagnostic information compared with sole cytologic examination in 14% of representative TBNA samples in patients with mediastinal lymph node enlargement. A discrepancy between cytologic and histologic TBNA results should prompt further investigation.