In recent years, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as an innovative technique for diagnosis and staging of lung cancer and has been successfully introduced into daily clinical practice with several advantages including minimally invasive approach, safe, cost-effective, real time image guidance, broad sampling capability, and rapid on-site evaluation (ROSE). Both cytological and histological approach could be useful to have material for diagnosis, immunohistochemical and molecular analyses which may be very important for targeted therapy with successful rate ranging from 89% to 98%. The utility of ROSE during EBUS-TBNA has been matter of debate. Indeed, although some evidence concluded that ROSE does not increase the diagnostic efficacy of EBUS-TBNA, other demonstrated that it improves the diagnostic yield of the procedure up to 30%, allows to avoid repetition of additional diagnostic procedures and reduces risk of complications. Furthermore the sample preparation by cytopathologist is optimized with the aid of direct macroscopic inspection, optimal smearing techniques, and triage of the sample permitting to obtain adequate tissue for diagnosis, ancillary techniques and molecular testing, when needed. Some pathological issues on EBUS-TBNA are reviewed and discussed with particular focus on ROSE and molecular testing.

译文

近年来,支气管内超声引导的TBNA (EBUS-TBNA) 已成为肺癌诊断和分期的创新技术,并已成功引入日常临床实践,具有多种优势,包括微创方法,安全,成本效益,实时图像指导,广泛的采样能力,和快速现场评估 (ROSE)。细胞学和组织学方法对于具有用于诊断,免疫组织化学和分子分析的材料可能是有用的,这对于靶向治疗可能非常重要,成功率从89% 到98%。罗斯在EBUS-TBNA期间的效用一直是争论的问题。实际上,尽管一些证据得出结论,ROSE不会增加EBUS-TBNA的诊断功效,但其他证据表明,它可以将手术的诊断产量提高到30%,从而避免重复其他诊断程序并降低并发症的风险。此外,在需要时,通过直接宏观检查,最佳涂片技术和样品分类来优化细胞病理学专家的样品制备,以获得足够的组织进行诊断,辅助技术和分子测试。回顾并讨论了EBUS-TBNA上的一些病理问题,特别着重于玫瑰和分子测试。

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