Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies
Publication Date: May 1, 2020
Last Updated: March 14, 2022
Guideline Statements
EBUS TBNA may be used, if available, for initial evaluation (diagnosis, staging, identification of recurrence/metastasis) of mediastinal and hilar lymph nodes, as well as centrally located parenchymal lesions visible with endobronchial ultrasound. (S)
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When performing EBUS TBNA, 19-, 21-, or 22-gauge needles may be used. (R)
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When performing EBUS TBNA, ROSE should be used, if available. (R)
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To achieve optimal diagnostic yield, when performing EBUS TBNA without ROSE, the bronchoscopist should perform at a minimum 3 and up to 5 passes, if technically and clinically feasible. When performing with ROSE, clinical judgment should be used to assess the number of passes needed. Additional passes may be required for ancillary studies. (R)
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When performing transthoracic needle procedures, ROSE should be used for adequacy assessment, if available and clinically feasible. If performing CNB without concurrent FNA, touch preparations may be used for adequacy assessment, if available.
- for the use of ROSE for adequacy assessment.
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- for the use of touch preparations without concurrent FNA.
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When performing transthoracic needle procedures, needle size should be determined by the operator and technique. For transthoracic FNAs, needles as small as 25 gauge may be used. For CNBs, needles as small as 20 gauge may be used. (R)
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When performing transthoracic FNA without CNB, the proceduralist should obtain multiple passes, if technically and clinically feasible, and should attempt to collect sufficient material for a tissue block (ie, cell block, tissue clot). (R)
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To achieve optimal diagnostic yield when performing transthoracic CNBs, the proceduralist should attempt to obtain a minimum of 3 core samples, if technically and clinically feasible. Additional samples may be required for ancillary studies. (R)
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If performing bronchoscopy for the investigation of peripheral pulmonary lesions that are difficult to reach with conventional bronchoscopy, imageguidance adjuncts may be used, if local expertise and equipment are available. (R)
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When performing transbronchial needle aspirates, ROSE should be used for adequacy assessment, if available. If performing transbronchial forceps biopsies without concurrent transbronchial needle aspirates, touch preparations may be used for adequacy assessment, if available.
- for the use of ROSE for adequacy assessment.
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- for the use of touch preparations.
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When collecting pleural fluid for a suspected diagnosis of malignancy, the proceduralist should send as much fluid volume as reasonably attainable for cytologic evaluation and ancillary studies. (EC)
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Cytology specimens (smears, cell blocks, liquid-based cytology), may be used for ancillary studies if supported by adequate validation studies. (S)
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CNB specimens collected for ancillary studies should be fixed in 10% neutral buffered formalin. (R)
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When performing bronchoscopy for the investigation of tuberculosis, endobronchial ultrasonography may be used to increase the diagnostic yield of bronchoalveolar lavage and transbronchial biopsy. (R)
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When performing EBUS TBNA for the evaluation of intrathoracic granulomatous lymphadenopathy with the suspicion of tuberculosis, specimens should be collected for cytology, microbiology (mycobacterial smear and culture), and TB-PCR evaluation, if available. (R)
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When collecting pleural fluid for diagnosis of extrapulmonary tuberculosis, specimens should be submitted for microbiology culture studies for mycobacteria using liquid media protocol. (R)
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Recommendation Grading
Overview
Title
Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies
Authoring Organization
College of American Pathologists
Endorsing Organizations
American College of Chest Physicians
American Thoracic Society
Association for Molecular Pathology
Publication Month/Year
May 1, 2020
Last Updated Month/Year
August 29, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies.
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Hospital, Outpatient
Intended Users
Laboratory technician, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management
Diseases/Conditions (MeSH)
D001706 - Biopsy
Keywords
Thoracic Small Biopsy, Cytology Specimens
Supplemental Methodology Resources
Methodology
Number of Source Documents
180
Literature Search Start Date
March 30, 2017
Literature Search End Date
April 30, 2019