Efficacy of conventional TBNA in patients with mediastinal adenopathies - A role of cytopathologist

Background: Despite a rapid growth of EBUS-TBNA, cTBNA is still an option for almost all patients with mediastinal adenopathies. Aim: To evaluate efficacy of cTBNA in a tertiary-care hospital comparing efficacy of routine cytology in host institution and highly experienced cytopathologist in reference hospital. Methods: 44 pts with malignant and benign mediastinal adenopathy were enrolled, all undergone flexible bronchoscopy in local anesthesia with cTBNA performed using 21G dedicated needle (Boston Scientific Excelon). Smears were sent to ordinary cytologist, and afterwards were re-checked by an expert. Quality of smears, and diagnostic yield were compared between two sites and subgroups (malignancy/benign disease). Results: Among 44 pts, 10 cases were diagnosed as sarcoidosis, 34 - as lung cancer. According to local cytology, only 3/10 cases with benign disease were diagnostic, all the rest did not show any signs of lymphnode. For malignancy, 15/34 cases were diagnostic, and 16/34 described as representative of a limphnode. After re-check by an expert, 8/10 of benign cases were representative, among them 6 were diagnostic (60% efficacy). For malignancy, 25/34 cases were representative, among them 18 were diagnostic. Conclusion: Level of expertise for cytopathologist is of crucial importance in assessment of cTBNA smears. Re-check of cytology slides by an expert can improve diagnostic yield in benign mediastinal adenopathy by factor two. For malignancy, increase of the yield is a bit less, but still substantial.