Role of fiberoptic bronchoscopy-guided needle aspiration cytology (EBNA) in diagnosing lung cancer in endobronchial lesions: A single-center experience

Abstract

Objectives: Globally, lung cancer is the leading cause of new cancer diagnosis and deaths. In spite of advancement in diagnostic modalities, lung cancer diagnosis is often delayed due to lack of bronchoscopy facility and techniques. In the present study, we have analyzed role of bronchoscopy in diagnosis of lung cancer with special emphasis on endobronchial needle aspiration (EBNA) cytology in comparison to other conventional diagnostic techniques (CDTs) such as bronchial wash (BW) and forcep biopsy (FB). Material and Methods: Prospective and observational study screened 1496 cases with suspected lung malignancy on clinical and radiological basis. Bronchoscopy guided techniques such as EBNA, BW, and FB are used in exophytic endobronchial lesions (EEL) in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BW and FB. Rapid on-site evaluation analysis of all EBNA samples done in pathology laboratory allied center. Finally, histopathology proven 893 lung malignancy cases are included in study. Statistical analysis is done using Chi-square test. Results: In the present study, 893 diagnosed lung cancer patients between 29 and 85 age groups; male is 60.02% (536/893) and females are 39.97% (357/893). Commoner radiological presenting features are mass lesion in 48.60% (434/893) cases, Hilar opacity in 33.37% (298/893) cases, and collapse segmental/lobar in 12.54% (112/893) cases. During bronchoscopy, anatomical location is documented on the right side of tracheobronchial in 57.33% (512/893) cases as compared to the left side of tracheobronchial wall 23.96% (214/893) and growth at carina documented in 18.70% cases (167/893) cases. Upper lobe bronchi are commoner site on both the sides as compared to other segmental bronchi. In the present study, yield of FB and FB plus BW in EEL is 84.65% (756/893) and 88.35% (789/893), respectively. Yield of EBNA, EBNA plus BW, and EBNA plus FB in EEL is 70.99% (634/893), 73.48% (656/893), and 99.66% (890/893), respectively. Overall, yield of all bronchoscopy guided techniques (EBNA + FB + BW) in our study in EEL is 100%. Additional yield of EBNA in EEL over other CDTs (CDTs such as FB plus BW) is 11.65%. Sensitivity of FB and EBNA in diagnosing lung malignancy in EEL is 84.65% and 70.99%, respectively. FB is more sensitive technique than EBNA in EEL (P < 0.00001). Sensitivity of FB plus BW in EEL is 88.35% (789/893). Sensitivity of EBNA plus BW in EEL is 73.48% (656/893). Sensitivity of EBNA plus FB in EEL is 99.66% (890/893) (P < 0.00001). Conclusion: EBNA has documented very crucial role in diagnosing lung cancer in comparison to other CDTs. Although FB is more sensitive test then EBNA in EEL in diagnosing disease, we have documented that EBNA has significant additive yield in proportionate number of cases. EBNA is safe, sensitive and cytology samples can give comparable results to histopathology.