|
|
|
2019, Volume 35, Number 2, Page(s) 092-101
|
|
|
DOI: 10.5146/tjpath.2018.01437 |
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Hilar and Mediastinal Lymph Node Metastases of Melanoma |
José-Fernando VAL-BERNAL1 , María MARTINO2, Elena YLLERA3, Félix ROMAY4, María SÁNCHEZ-ARES5, Ihab Abdulkader NALLIB5 |
1Pathology Unit, Medical and Surgical Sciences Department, University of Cantabria and IDIVAL Research Institute, SANTANDER, SPAIN
2Anatomical Pathology Service, Marqués de Valdecilla University Hospital, University of Cantabria and IDIVAL Research Institute, SANTANDER, SPAIN
3Radiodiagnostic Service, Marqués de Valdecilla University Hospital, SANTANDER, SPAIN
4Neumology Service, Marqués de Valdecilla University Hospital, SANTANDER, SPAIN
5Anatomical Pathology Service, University Hospital, Santiago de Compostela, SPAIN |
Keywords:
Melanoma, Metastasis, Bronchoscopy, Cytology, Immunohistochemistry |
Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for investigating
hilar and mediastinal lymphadenopathy. This study reports eleven cases in which EBUS-TBNA was used to assess mediastinal and hilar lymph
nodes for the presence of metastatic melanoma.
Material and Method: A retrospective study was performed of all patients who had a history of melanoma and underwent EBUS-TBNA to assess
hilar or mediastinal lymphadenopathy for the presence of metastatic melanoma. In seven cases, molecular analysis to detect mutations in the
BRAF gene was also used.
Results: Eight patients had been diagnosed with malignant melanoma in the past (mean 54.4 months, range 18 to 115 months) while in the other
three this tumor was primarily diagnosed in the staging phase. The male-female ratio was 6:5, and the mean age was 60.3 years (range 42 to 88
years). The mean hilar or mediastinal lymph node size detected with computed tomography was 3.0 cm (range 1.1 to 8.1 cm). Eight (72.7%)
cases had metastases to the lung associated with metastases in the mediastinal lymph nodes. In four (50%) of these cases, the lung metastasis was
solitary. Three (27.3%) cases had metastases in the mediastinal lymph nodes in absence of lung metastases. Metastatic melanoma was diagnosed
by cytology and confirmed by cell block study with immunohistochemistry in all cases. BRAF mutations were detected in two (28.6%) of seven
cases studied.
Conclusion: Cytology and tissue samples obtained from EBUS-TBNA are adequate to detect metastatic melanoma and permit in some cases the
determination of biomarkers and identify the presence or absence of mutations in the BRAF gene. The procedure is safe, fast, and precise for the
staging of melanoma.
|
|
|
|
|
