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BACKGROUND:Endobronchial ultrasound EBUS is a relatively new modality that can be used to guide transbronchial needle aspiration TBNA of mediastinal and hilar lymph nodes and peripheral lung lesions. Few studies have investigated the cytological profile of EBUSTBNA specimens. In this study, we have reviewed the cytological profile of 135 consecutive cases, including 71 lymph node cases, 4 lung cases, and 60 cases of both lymph node and lung sampling. Our study contains the largest number of cases in the evaluation of cytomorphology.METHODS:The cytological specimens were collected using an ultrasound bronchofibervideoscope with a 22gauge needle and core biopsies were obtained with a 19gauge needle. An experienced cytotechnologist performed an immediate onsite evaluation of adequacy. An immediate assessment was given to the clinician after each pass. In many patients, multiple sites were sampled. The average slides of each case were 9.9 median of 12, with a range from 2 to 24.RESULTS:Of 131 cases of lymph node sampling, 45 cases 34.6 were diagnosed as malignant, 73 cases 55.7 as benign process, 5 cases 3.8 as suspicious for malignancy, and 1 case 0.8 as atypical cells. Of the 64 cases of lung lesion sampling, 21 cases 32.8 were diagnosed as malignant, 35 cases 54.7 as benign process, 1 case 1.5 as suspicious for malignancy, and 4 cases 6.3 as atypical cells. The lymph node nondiagnostic rate was 5.3, whereas the nondiagnostic rate for lung lesions was 4.7. Eightyeight cases 65.2, 88135 had corresponding core biopsies with a 19gauge needle or followup surgery. When histology was taken as the gold standard, the sensitivity, specificity, and positive and negative predictive values for EBUSTBNA were 85.0, 100, and 100 and 89.7, respectively. However, when both histology and clinical followup were considered together, the overall sensitivity and negative predictive values were increased to 94.7 P< .05 and 96.6 P< .05, respectively.CONCLUSIONS:This study shows that EBUSTBNA is an accurate and sensitive method for diagnosing and staging lung cancer. The constant challenge that we as cytopathologists are now facing is how to improve our diagnostic ability and accuracy for lung cancer. We believe that this optimal goal can be achieved with the effective use of EBUSTBNA sampling and collaboration with our clinical colleagues. Cancer Cancer Cytopathol 2009. © 2009 American Cancer Society.