Does anthracosis reported in endobronchial ultrasound‑guided transbronchial needle aspiration exclude metastasis?

Abstract

OBJECTIVES: In some studies, it has been hypothesized that anthracotic pigmentation in mediastinallymph nodes is a sign of benign conditions and excludes metastasis from thoracic and extrathoracicmalignancies. The aim of this study was to evaluate the clinical significance of mediastinal lymphnode anthracosis in cancer patients who underwent endobronchial ultrasound‑guided transbronchialneedle aspiration (EBUS‑TBNA).MATERIALS AND METHODS: In this study, medical data of patients with lung cancer or extrathoraciccancer who underwent EBUS‑TBNA for investigation of mediastinal lymph node metastasis wereevaluated retrospectively. EBUS‑TBNA cytology reported as anthracotic pigmentation was includedin this study. Patients were excluded from the study if cytology of aspirated lymph nodes reportedas “benign,” “malignancy,” or “granulomatous inflammation.”RESULTS: There were 50 eligible patients. Thirty‑one (62%) patients underwent EBUS‑TBNA forlung cancer staging and 19 (38%) for evaluation of extrathoracic metastasis. A total of 120 lymphnodes were sampled. The most sampled station was subcarinal. EBUS‑TBNA was false negativein eight of 31 (25.8%) lung cancer patients and one of 19 (5.2%) extrathoracic malignancy patients.CONCLUSIONS: Anthracotic pigmentation of lymph nodes in EBUS‑TBNA cannot exclude metastasisin lung cancer patients and mediastinoscopy should be performed before surgery in this group. Inpatients with extrathoracic malignancy, anthracotic pigmentation is associated with benign conditions.However, further investigation with larger cohort is needed.