Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Management of Breast Cancer Detects Triple-Receptor Discordance.

SESSION TYPE: Endobronchial UltrasoundPRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PMPURPOSE: Metastasis of breast cancer to intrathoracic lymph nodes is common and the biopsy of suspicious lesions can have important diagnostic, prognostic and therapeutic implications, in particular tumor receptor status. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, efficient tool in sampling mediastinal lymphadenopathy, but its role in the management of breast cancer while appealing is unproven.METHODS: A retrospective chart review of consecutive adult patients undergoing EBUS-TBNA from May 2007 to July 2012 was performed. Data collected and analyzed included previous pathology, imaging, treatment history, bronchoscopy reports and pathology results.RESULTS: Forty-nine females with a history of breast cancer ages 31 to 80 had EBUS-TBNA for the evaluation of mediastinal lymphadenopathy. A total of 59 suspicious lymph nodes were biopsied between 0.4 to 3 cm's in diameter. Forty-four (90%) patients had diagnostic cytology for malignancy or benign lymphoid tissue. Breast malignancy was identified in 21 (43%) patients and 15 (71%) of these had sufficient samples for the evaluation of estrogen, progesterone and HER-2 receptors status. For those whose biopsies were greater than 6 months from the time of initial diagnosis, 5/14 (36%) had discordant triple-receptor status from the initial biopsy.CONCLUSIONS: EBUS-TBNA proved to be a useful tool for evaluating mediastinal lymphadenopathy in patients with a history of breast cancer. The technique has an excellent diagnostic yield and may provide additional information for prognosis and therapeutic planning. In particular, triple-receptor discordance between the initial diagnostic tissue and subsequent mediastinal lymphadenopathy was common and may play an important role in deciding future therapy.CLINICAL IMPLICATIONS: EBUS-TBNA may decrease the need for more invasive mediastinal procedures in patients with breast cancer and may have significant diagnostic, prognostic and therapeutic implications.DISCLOSURE: The following authors have nothing to disclose: Daniel Gilstrap, Momen WahidiNo Product/Research Disclosure InformationDuke University Medical Center, Durham, NC.