LQHS2503 - CMLE - Optimum Triage of Endocsopy-Guided Cytology Specimens-Optimum Triage of Endocsopy-Guided Cytology Specimens

Optimum Triage of Endocsopy-Guided Cytology Specimens

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This document outlines best practices and considerations for handling cytology specimens obtained via endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) in diagnosing and managing thoracic neoplasms, especially non-small cell lung cancer (NSCLC).<br /><br />A case of a 65-year-old woman with pulmonary nodules and mediastinal lymphadenopathy is described. Initial specimen handling by a newly trained cytologist resulted in insufficient tissue preservation for further testing. The procedure was paused due to patient bleeding, but later resumed under expert guidance utilizing the 'pick and smear' technique. This method involves carefully selecting small tissue fragments from needle passes onto glass slides to create both air-dried and alcohol-fixed smears, while reserving additional material in formalin for cell block preparation, thus maximizing diagnostic and ancillary testing potential.<br /><br />The document emphasizes the growing importance of optimal specimen triage due to the increasing demand for molecular and immunohistochemical testing essential for personalized therapy. Key recommendations from the College of American Pathologists (CAP) include performing rapid on-site adequacy assessments (ROSE) when possible, ensuring at least 3-5 passes are collected if ROSE is unavailable, and using appropriate fixatives and media to preserve tissue for biomarker and molecular analyses.<br /><br />Common biomarkers—such as PD-L1, TTF-1, CK7, ALK, ROS1, and emerging markers like HER2—are crucial for diagnosis and targeted therapy. Pre-analytical factors, including fixation methods and specimen handling, significantly impact test accuracy, with certain fixatives posing a risk for false negatives.<br /><br />The facility’s ‘pick and smear’ technique achieved a 70% adequacy rate on ROSE and 80% adequacy for final diagnosis and molecular testing, illustrating effective specimen management. The report concludes that no single triage protocol fits all settings; centers should tailor SOPs to their resources and expertise. Timely and judicious tissue handling is critical in the era of precision medicine for thoracic malignancies.

Keywords

endobronchial ultrasound

transbronchial needle aspiration

cytology specimens

non-small cell lung cancer

pick and smear technique

rapid on-site evaluation

biomarker testing

molecular diagnostics

specimen handling

thoracic neoplasms