CONTENTS:

2.7 Making the Tissue Diagnosis: Lung cancer Biopsy
2.7.1 Obtaining the Tissue Biopsy
2.7.2 Endobronchial Ultrasound-Guided (EBUS) Biopsy
2.7.3 Cytology Specimens
2.7.4 Lung Cancer Biopsy Specimens
2.7.5 Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) of Lymph Nodes

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Looking back, I find that nostalgia isn’t what it used to be.

2.7 Making the Tissue Diagnosis

 
Microscopic analysis (histology or pathology) of the lung tissue is required to make a lung cancer diagnosis.  The diagnostic sample may be cytology (cell) or histology (tissue) samples.

A tissue biopsy is preferable to a cytology specimen if the ease and risks of taking both types of  specimens are equal. This is because the appearance of the way that the cells group together, as sheets (squamous carcinoma) or as glands (adenocarcinoma) requires tissue.  In addition, sufficient material for immunohistochemical and genetic analysis of the tumor also requires tissue from a biopsy (see Section 6).

2.7.1 Obtaining the Tissue from a Lung Cancer Biopsy

 
Minimally invasive procedures, such as endoscopy, are preferred to more invasive procedures.  Indeed, more invasive procedures include video-assisted thoracic surgery (VATS) and mediastinoscopy for the initial biopsy.

For patients with peripheral stage IA disease, surgical biopsy is sometimes preferred because diagnosis and curative resection may occur simultaneously.

What is a mediastinoscopy?

The mediastinum lies behind the breast bone and contains the heart, oesophagus, trachea, nerves, lymph nodes and the thymus gland.

That helps, so a mediastinoscopy looks at this area?

Yes. A mediastinoscopy with a biopsy is a surgical procedure for examining the chest and lungs and taking tissue samples of any abnormalities.

2.7.2 Endobronchial Ultrasound-Guided (EBUS) Biopsy

 
Endobronchial ultrasound guided biopsy (EBUS) is now one of the most common techniques used for diagnosis and staging of suspected lung cancer.

The technique of EBUS has a high diagnostic accuracy for accessing central primary tumors and for most mediastinal lymph nodes.

However, sometimes the initial tissue sampling provides inconclusive results or is insufficient for essential diagnostic immunohistochemical or molecular characterization. In this case a second lung cancer biopsy procedure may be necessary.  The selection of a second biopsy procedure should favour techniques with a higher diagnostic yield (e.g. surgical lung cancer biopsy).

So we have e-mails, e-books and now the e-bus, Cool!

No Hector, the ‘e’ here stands for ‘Endobronchial’ not ‘Electronic’.

What is an Endobronchial Ultrasound guided biopsy?

A bronchoscope is inserted through the mouth and allows for real time imaging of the airways, blood vessels, lungs and lymph nodes. Biopsy of any abnormalities can also be performed.

2.7.3 Cytology Specimens

 
Cytological specimens are obtained from the following bodily sites:

Lung: Sputum, transthoracic needle aspirates, and bronchoscopic washings, brushings, or needle aspirates.

Lymph node: Transthoracic, transbronchial, and transesophageal aspirates.

Distant metastasis: Pleural fluid, needle aspirates of metastatic tissue (e.g., liver).

2.7.4 Lung Cancer Biopsy Specimens

 
Core or biopsy tissue is obtained from the following sites:

Lung: Bronchoscopic (forceps) and transthoracic (needle) biopsy, surgical biopsy.

Lymph node: Bronchoscopic and transthoracic needle core biopsy, surgical biopsy.

2.7.5 Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) of Lymph Nodes

 
In 2008,  Herth and colleagues reported that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can reliably sample enlarged mediastinal lymph nodes in patients with non-small-cell lung cancer (NSCLC).

EBUS-TBNA is used to sample lymph nodes that have been detected on CT or positron emission tomography (PET).

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References:

 
Herth FJ, Eberhardt R, Krasnik M, Ernst A. (2008). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. (Retrieved 8^th April 2015): http://www.ncbi.nlm.nih.gov/pubmed/18263680

Henschke CI, Yip R, Yankelevitz DF, Smith JP; International Early Lung Cancer Action Program (ELCAP) Investigators. (2013). Definition of a positive test result in computed tomography screening for lung cancer: a cohort study. Ann Intern Med. 158(4), 246-52. (Retrieved 22^nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/23420233
 

More references for this section are on this page..

Patient Information:

 
Cancer Treatment Centers of America Endobronchial ultrasound (EBUS). (Retrieved 23^rd March 2015): http://www.cancercenter.com/treatments/endobronchial-ultrasound/

American Lung Association Diagnosing Lung Cancer. (Retrieved 8^th March 2015)

More patient information for this section is on this page.
 

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