Sara E. Monaco, MD, and Walid E. Khalbuss, MD, PhD, University of Pittsburgh Medical Center, Pittsburgh, PA
Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) and transesophageal endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) are two relatively novel techniques utilizing FNA and are gaining popularity due to their success in sparing patients from having more invasive procedures (e.g. EBUS-guided FNA for lung cancer staging in lieu of mediastinoscopy). The on-site evaluation of these FNAs is essential in order to answer an important question (ex. neoplastic vs. non-neoplastic) and to decide if a more invasive procedure is required. Due to the importance of the clinical decisions and the need to have rapid answers based on limited material, it is essential for pathologists to understand how far they can go in their immediate assessment and how the diagnosis rendered will impact the surgical decision making. This workshop will allow us to share the perspective of the cytopathologist with an emphasis on the diagnostic challenges and the clinical implications of the immediate evaluation to the surgeon. The course will address medical knowledge and practice-based improvement through the use of cases that we have identified in our busy practice, including cases addressing adequacy issues, granulomatous inflammation, non-small cell carcinomas, neuroendocrine tumors (small cell carcinoma vs. large cell neuroendocrine carcinoma), and non-epithelial tumors (e.g. lymphomas, etc.), in addition to illustrative cases demonstrating the differential diagnosis and pitfalls to be aware of in these scenarios.
The course will have an introductory didactic portion discussing the diagnostic utility of EBUS and EUS-FNA, and a practical diagnostic approach to these types of FNAs. Then case-based discussions will be utilized to introduce the important issues and challenging cases in EBUS and EUS-guided FNAs. The cases will be presented in a sequential manner, starting with clinical history and radiological imaging information, on-site images, on-site diagnosis, final diagnosis, and histological follow-up. A detailed differential diagnosis with illustrative examples and pitfalls will also be shown for each case. The cases will include common and less common diagnostic entities that can be seen in these mediastinal FNAs, in addition to the pitfalls that can be encountered and the implications of the on-site evaluation to the treating physician. The course is designed for residents, fellows, cytopathologists, and general pathologists, particularly those with an interest in mediastinal or thoracic pathology and/or a desire to learn about this relatively novel application for FNA.
Upon completion of this educational activity, participants should be able to: 1) Demonstrate the diagnostic value and advantages of EBUS and EUS- guided FNA; 2) Employ a practical cytological approach to making a diagnosis in EBUS & EUS-guided FNAs; 3) Explain the implications of the cytological diagnosis rendered to the treating thoracic surgeon or clinician; 4) Recognize the pitfalls and diagnostic challenges in EBUS and EUS-guided FNAs; and 5) Discuss the utility of ancillary studies that can be utilized in EBUS and EUS-guided FNAs.
Case histories, virtual slides, and static images will be available on the USCAP website for review by registrants prior to the course. A detailed syllabus with a review of differential diagnoses and key points will be distributed to registrants at the meeting. After the meeting, all registrants will receive web access to the PowerPoint presentation given at the USCAP Annual meeting, along with the text portion of the syllabus.