J Korean Med Sci.  2013 Apr;28(4):550-554. 10.3346/jkms.2013.28.4.550.

Clinical Implication of Microscopic Anthracotic Pigment in Mediastinal Staging of Non-Small Cell Lung Cancer by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

• Park YS
• Lee J
• Pang JC
• Chung DH
• Lee SM
• Yim JJ
• Yang SC
• Yoo CG
• Kim YW
• Han SK

• KMID: 1786962
• DOI: http://doi.org/10.3346/jkms.2013.28.4.550

Abstract

Microscopic anthracotic pigment (MAP) is frequently observed in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen in non-small cell lung cancer, but its clinical interpretation is not well-known. The aim of this study was to evaluate the clinical implication of MAP in mediastinal staging of non-small cell lung cancer. From May 2010 to July 2011, consecutive potentially operable non-small cell lung cancer patients who underwent EBUS-TBNA for mediastinal staging were recruited. Of the total 133 patients, 102 (76.7%) were male patients. Median age was 68 yr. Total 279 mediastinal lymph nodes were sampled by EBUS-TBNA; station 4R (100, 35.8%) and station 7 (86, 30.8%) were the most common sites. Malignant lymph nodes were 100 (35.8%). MAP was observed in 61 (21.7%) lymph nodes, and among them only 3 were malignant lymph nodes (P < 0.001). The lymph nodes with MAP were smaller (9.0 vs 10.8 mm, P = 0.001) and showed low standard uptake values on FDG-PET (4.4 vs 4.7, P = 0.256). In multivariate analysis, MAP was negatively associated with malignant lymph node (adjusted OR, 0.12; 95% CI, 0.03-0.42; P < 0.001). In potentially operable non-small cell lung cancer patients, MAP in endobronchial ultrasound-guided transbronchial needle aspiration specimens is strongly associated with benign mediastinal and hilar lymph nodes.

Keyword

Lung Cancer; Staging; Endobronchial Ultrasound; Anthracotic Pigment

MeSH Terms

Adult
Aged
Aged, 80 and over
Bronchoscopy
Carbon/chemistry
Carcinoma, Non-Small-Cell Lung/*pathology
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Humans
Lung Neoplasms/*pathology
Lymph Nodes/pathology
Lymphatic Metastasis
Male
Mediastinal Neoplasms/*pathology
Middle Aged
Multivariate Analysis
Neoplasm Staging
Positron-Emission Tomography
Carbon

Figure

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  Fig. 1 Microscopic anthracotic pigment in lymph node acquired from endobronchial ultrasound-guided transbronchial needle aspiration. Dark brown pigment was observed in the inflammatory cells in (A) aspiration cytology (staining with Papanicolaou) and (B) tissue core (staining with hematoxylin and eosin) from the same patient (×400).

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