Transbronchial needle aspiration staging of bronchogenic carcinoma

Transbronchial needle aspiration (TBNA) has been advocated as a reliable technique in the nonsurgical staging of patients with bronchogenic carcinoma. Some have questioned the reliability of TBNA, however. We used TBNA directed by computed tomography (CT) in 88 consecutive patients with bronchogenic carcinoma who had undergone chest CT. Chest CT was 94% sensitive, 79% specific, and 85% accurate in evaluating the mediastinum for malignant lymphadenopathy. There were 19 malignant aspirates in 44 patients with malignancy and apparent adenopathy evaluated by chest CT. No malignant carinal aspirates were obtained in any patient with a normal mediastinum evaluated by chest CT. There were 2 false positive needle aspirates. One patient with apparent right paratracheal adenopathy and malignant needle aspirate had no mediastinal neoplasm detected at surgery. The other false positive aspirate had been contaminated by tracheal debris. The overall sensitivity, specificity, and accuracy of TBNA mediastinal staging were 50, 96, and 78%, respectively. We conclude that CT scanning is a useful adjunct in the staging of patients with bronchogenic carcinoma, and that TBNA is a sensitive and highly specific staging technique that may negate the need for surgical staging in a large number of patients with bronchogenic carcinoma.     

Transbronchial needle aspiration (TBNA) in the early diagnosis and staging of bronchogenic carcinoma

BACKGROUND: Transbronchial needle aspiration (TBNA) has evolved as a useful technique to establish diagnosis in patients suspected of having bronchogenic carcinoma. METHODS: Transbronchial needle aspiration (TBNA) was done in twenty-five patients with either proved or suspected bronchogenic carcinoma using a flexible bronchoscope. Results of 19 patients who had pulmonary malignancy were analysed. RESULTS: In the 12 patients with endobronchially visible abnormality, TBNA could correctly identify eleven patients with carcinoma and one patient, who was a treated case, with no evidence of residual disease. In the seven patients with bronchoscopically invisible extrabronchial disease, TBNA could identify four patients with malignancy and also characterize true negative disease in a treated case with subcarinal lymph node. TBNA could define the correct cytology in all the patients with visible tumours and in 59% of patients with bronchoscopically invisible tumours. The procedure was diagnostic in 84% of the cases. Mediastinal lymph node sampling in nine patients by TBNA, with the help of contrast enhanced CT scans, was positive in five patients and negative in the other four patients thus helping in nodal staging. CONCLUSIONS: Although the sample size of the study was small, the procedure was found to be very useful for the early diagnosis and staging of bronchogenic carcinoma. It was safe, well tolerated and no untoward complications were observed.     

Transbronchial fine needle aspiration of bronchogenic cysts

Transbronchial fine needle aspiration (TBFNA) was used to confirm the diagnosis of bronchogenic cyst in two asymptomatic patients with mediastinal masses who declined surgical exploration. Both masses were located subcarinally but differed in computed tomographic density (7 and 59 Hounsfield units). Aspirate cytology demonstrated predominately bronchial columnar epithelial cells in mucus, without the lymphocytes and polymorphonuclear leukocytes normally seen in intrabronchial secretions. The denser cyst additionally contained some alveolar macrophages with ingested surfactant. While benignity cannot be absolutely assured, it is corroborated by serial evaluation of these patients, which has revealed no interval change in symptoms or roentgenographic size for two and three years, respectively. Under selected circumstances, it appears that TBFNA can be used to extend bronchoscopic diagnosis to benign mediastinal masses if the cytologic features of such aspirates are unique.     

Evaluation of transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma

Transbronchial Needle Aspiration (TBNA), utilizing the flexible fibrobronchoscope, was one of the diagnostic procedures administered to the 148 cases examined. By means of the combination of transbronchial biopsy with brushing, 110 of those 148 patients were determined to have lung cancer. Thus, the diagnostic yields of TBNA, biopsy and brushing were 70.9% (78/110) 69.09% (76/110) and 65.45% (72/110) respectively. TBNA combined with the forceps biopsy increased the diagnostic yields to 91.81% (101/110), and combined with forceps and brushing increased the diagnostic yields to 93.63% (103/110). Additionally, 38 among 148 cases with negative results in TBNA were finally proven not to have bronchogenic carcinoma. No false positive was detected. There were no serious complications in this series. Our study demonstrates that TBNA is a relatively simple, safe and effective technique in diagnosing patients suspected with lung cancer; it can be used in combination with biopsy of forceps and brushing.     

Transbronchial needle aspiration in the diagnosis of intrathoracic lymphadenopathy

BACKGROUND: Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes has been shown to be useful in the diagnosis and staging of bronchogenic carcinoma. The usefulness of TBNA has not been widely investigated in benign disease other than sarcoidosis. OBJECTIVES: We investigated the diagnostic value of TBNA in consecutive patients who were referred to Yedikule Hospital of Chest Disease and Thoracic Surgery because of mediastinal and/or hilar adenopathy. METHODS: A total of 29 TBNA procedures were performed in 28 patients who had mediastinal or hilar adenopathy identified by computed tomography of the chest. TBNA of enlarged lymph nodes was performed using a flexible bronchoscope (BF 30T, Olympus) and a 19-gauge needle capable of obtaining core biopsy specimens (MW-319 Mill-Rose Laboratories, Mentor, Ohio, USA) from endobronchial or endotracheal locations. All patients had at least three examinations of sputum smears for acid-fast bacilli prior to bronchoscopy and the results of sputum smears were found to be negative. RESULTS: Adequate lymph node samplings were obtained by TBNA in 23 of 29 (79%) procedures. Diagnostic samples were obtained by TBNA in 20 of 29 (69%) procedures. We were able to make a diagnosis in 20 of 23 (87%) patients in whom adequate lymph node samples were obtained by TBNA. TBNA was the only means of diagnosis in 13 of 28 (46%) patients. The diagnoses provided using TBNA were tuberculosis in all of 10 patients (100%), sarcoidosis in 7 of 8 patients (87.5%), lymphoma in 1 of 2 patients (50%), small cell carcinoma in 1 patient and nonspecific lymphadenitis in 1 patient. No complication was observed and there was only minimal bleeding. CONCLUSIONS: We conclude that TBNA, using 19-gauge histologic needles through a flexible bronchoscope, is a valuable tool in the diagnosis of intrathroracic adenopathy, particularly in patients with tuberculosis and sarcoidosis. TBNA should be considered in the diagnosis of intrathoracic adenopathy before other invasive procedures.     

Transbronchial needle aspiration

To determine the value of transbronchial needle aspiration biopsy in the diagnosis of sarcoidosis, we reviewed a one-year experience of consecutive patients with sarcoidosis presenting with hilar and/or paratracheal adenopathy. The sensitivity of transbronchial needle aspiration biopsy in obtaining noncaseating granulomas was 90%. This yield exceeds that of most published reports of transbronchial lung biopsy and bronchial mucosal biopsy and suggests that transbronchial needle aspiration biopsy may be a valuable diagnostic tool in the evaluation of these forms of sarcoidosis.     

False-positive transbronchial needle aspiration in bronchogenic carcinoma

In a patient with bronchogenic carcinoma, a transbronchial needle aspiration of subcarinal and paratracheal lymph nodes was performed for purposes of staging. On cytologic examination of the specimen, a clump of malignant cells was found; however, subsequent mediastinoscopy and thoracotomy showed no evidence of metastases to mediastinal lymph nodes. We postulate that specimens from transbronchial needle aspiration can be contaminated with tumor cells located on the airway surface epithelium.     

Transbronchial needle aspiration in the diagnosis and staging of lung cancer

OBJECTIVES: This study was aimed to determine effects of transbronchial needle aspiration (TBNA) in diagnosis and staging of lung cancer. METHODS: Records of 55 patients who underwent TBNA in our Chest Department from February 2002 to December 2004 were reviewed retrospectively. RESULTS: Out of 55 patients who had undergone TBNA, 30 were diagnosed to have lung cancer after complete work up. Transbronchial needle aspiration was positive for malignant cells in 12 out of 20 lung cancer patients with mediastinal lymphadenopathy on computed tomographic scan (CT scan) of the thorax. Mediastinoscopy was positive for malignancy in three cases and the remaining five had bulky lymph node enlargement which was considered malignant, given the histologic diagnosis established by other methods. Transbronchial needle aspiration was also positive for two other patients who had lymph nodes less than 1 cm size. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of TBNA in the diagnosis of lung cancer patients were 58%, 100%, 100%, 37% and 66%, respectively. CONCLUSIONS: The study demonstrates that TBNA is an efficient procedure in the diagnosis and staging of lung cancer. The diagnostic yield is increased when there is lymph node enlargement on CT scan of the thorax and reduces the need for mediastinoscopy.     

Transbronchial needle aspiration in the diagnosis of pneumonia in a canine model

We evaluated the risk, sensitivity, and specificity of transbronchial needle aspiration (TBNA) in a canine model of unilateral Streptococcus pneumoniae pneumonia and compared the results with our previous studies of these parameters in transthoracic needle aspiration (TTN), a catheter-brush (CB), and transbronchial biopsy (TBB) in the same model. The TBNA was performed in 10 dogs with right lower lobe S. pneumoniae pneumonia. The procedure was uncomplicated, but both the sensitivity and specificity were low (3 of 10 cultures yielded S. pneumoniae; only 1 of the 3 was a pure culture). This compares unfavorably with our experience with the other procedures: 9 of 10 cultures were pure with TBB and CB, and the remaining culture was sterile; 10 of 10 were pure with TTN. Given the present unprotected form of the bronchoscopic aspirating needle, TBNA does not appear to be useful in the diagnosis of bacterial pneumonia despite its usefulness in the diagnosis of intrathoracic malignancy.     

Transbronchial biopsy and needle aspiration

Transbronchial biopsy and transbronchial needle aspiration greatly increase the utility of bronchoscopy in the diagnosis of a variety of disease processes. Transbronchial needle aspiration has brought into focus the importance of good cytopathologic support. The addition of histologic specimens (for light and electron microscopy) with the newer large-bore needles may further increase the utility of transbronchial needle aspiration. Both techniques are limited, in part, by the lack of distal tip deflection of the sampling instrument for steering accurately to peripheral masses. Tip deflection may have been partly responsible for the good yields reported for the double-hinged curet on small nodules, although the bronchographic map was also a factor. A steerable brush was described several years ago, but it was somewhat difficult to accurately maneuver, and long-term results were never reported. As yet, no easy answer is available for this problem. In the future, new generations of ultrathin bronchoscopes may permit much more accurate placement of sampling devices in the periphery of the lung and will represent an exciting diagnostic advance.     

经支气管镜针吸活检术对纵隔及肺部疾病的诊断意义

目的探讨经支气管镜针吸活检术对纵隔淋巴结肿大及支气管腔外肺肿瘤诊断中的作用。方法对胸部CT检查发现的24例单纯纵隔淋巴结肿大、18例肺部病变合并纵隔淋巴结肿大及37例新生物生长在管腔外的患者进行经支气管镜针吸活检术和常规检查（病变处活检、刷检）,观察其诊断阳性率结果常规检查确诊21例,诊断阳性率为26.58%,针吸术确诊68例,诊断阳性率为86.08%;两种方法联合确诊70例,诊断阳性率为88.61%。其不良反应较少,43.0%的患者穿刺部位有少量出血。结论认为针吸术用于诊断以上纵隔及肺部疾病具有创伤小、阳性率高等优点。     

Transbronchial needle aspiration for histology specimens

Fine-gauge (22-G) transbronchial needle aspiration (TBNA) has significantly added to the diagnostic yield of FOB, and in some institutions has become routine in staging bronchogenic carcinoma. Cytologic examination of the specimen obtained by n228G TBNA, however, has several limitations. The mediastinal aspirate can be contaminated by tumor cells from respiratory secretions, giving false positive diagnoses of unresectability. The diagnosis of benign conditions can seldom be made. Using 18-G TBNA, we can obtain specimens for histologic examination from paratracheal, peribronchial, and carinal areas by FOB. Both 18-G and 22-G TBNA were performed in 34 patients with radiographic abnormalities involving mediastinal or hilar areas. Tissue for histologic examination was obtained in 17 patients (50 percent) using 18-G TBNA and was diagnostic in 11 (32 percent), including three patients with benign conditions. The overall diagnostic yeild of 18-G TBNA was 41 percent (14/34 patients), increasing the yield of FOB from 50 percent to 58 percent. There were no false positive results and few minor complications. 18-G TBNA is effective in obtaining tissue for histologic examination and diagnosing benign conditions. In selected cases this technique increases the diagnostic yield of FOB.     

经支气管针吸活检的临床应用探讨

目的 探讨经过ＣＴ引导下经纤维支气管镜（纤支镜）针吸活检（ＴＢＮＡ）的训练后,在日常纤支镜检过程中开展ＴＢＮＡ的方法和效果。方法 运用Ｗａｎｇ氏纵隔淋巴结及穿刺定位方法,结合ＣＴ片定位方法对纵隔增大淋巴结进行定位,在常规纤支镜检查中利用ＴＢＮＡ方法分别对１００例患者的１５２个纵隔增大淋巴结进行抽吸活检。结果 ＴＢＮＡ检查的诊断阳性率为６４％,琚ＣＴ引导下的检查结果（６１％）相比差异无显著性。结论     

Transbronchial needle aspiration of peripheral pulmonary nodules

To determine the role of transbronchial needle aspiration (TBNA) in the diagnosis of peripheral pulmonary lesions, TBNA was performed in 20 patients who had unexplained nodules (15) or masses (five) and no endobronchial abnormality. The TBNA cytopathology was positive for malignancy in 11 patients, and provided the only diagnostic specimen in seven. The TBNA yield was significantly higher than that of forceps biopsy or bronchial brushing, either alone or in combination (p less than 0.05). The procedure was complicated by pneumothorax in one patient. Transbronchial needle aspiration is diagnostically useful and safe for evaluation of the peripheral pulmonary nodule.     

Transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis

STUDY OBJECTIVE: To assess the role of transbronchial needle aspiration (TBNA) in diagnosing intrathoracic tuberculous lymphadenitis (TB-LA). METHODS: In a tertiary referral center for thoracic medicine and surgery, using a CT scan as a guide, transbronchial aspirates were obtained with a 19-gauge flexible histology needle in consecutively enrolled patients with sputum smears negative for acid-fast bacilli, and with isolated mediastinal or hilar adenopathy suspicious for tuberculosis (TB). RESULTS: Of 84 eligible patients who were all found to be HIV-negative, 63 (75%) cases of TB were diagnosed by TBNA (histology, 48 patients [76%]; cytology, 9 patients [14%]; and bacteriologic studies, 21 patients [33%; smear, 8 patients; culture, 17 patients]). TBNA was used to diagnose sarcoidosis in two patients, angioimmunoblastic lymphadenopathy in one patient, and Hodgkin lymphoma in one patient. In the 17 TBNA-negative patients, the results of transthoracic needle aspiration were positive in 12 patients (TB, nine patients; lung cancer, two patients; sarcoidosis, one patient), the results of mediastinoscopy were positive in three patients (TB, two patients; Hodgkin lymphoma, one patient), and the results of thoracotomy were positive in two patients (TB, two patients). Thus, 76 patients had TB, and all responded to anti-TB treatment. TB was corroborated by culture or histology of another specimen obtained from subsequently developed lesions in 40 patients (53%) during anti-TB treatment or posttreatment follow-up. TBNA was immediately diagnostic in 59 patients (78%), and exclusively in 52 patients (68%), among all bronchoscopic procedures and prebronchoscopic sputum studies. Sensitivity, specificity, positive and negative predictive values, and accuracy of TBNA for TB were 83%, 100%, 100%, 38%, and 85%, respectively. The only complication, self-limiting hemorrhage of < 30 mL volume, occurred in 65 patients (77%), with a volume of < 5 mL in 59 patients (70%). CONCLUSION: TBNA is efficient and safe in the bacteriologic and pathologic diagnosis of intrathoracic TB-LA in HIV-negative and sputum smear-negative patients.     

Transbronchial needle aspiration in routine fiberoptic bronchoscopy.

The objective of this study was to evaluate the yield of transbronchial needle aspiration (TBNA) in a clinical routine setting of a teaching hospital for the diagnosis and staging of bronchogenic carcinoma in comparison to the results of controlled clinical studies. We reviewed our results with Wang retractable needle catheters during a 9-month period. The needle catheters were used in 72 patients. 43 patients had a final diagnosis of bronchogenic carcinoma. Classical bronchial washes, brushings and forceps biopsies led to the diagnosis in 28 patients (65%). The addition of TBNA increased the diagnostic yield by 14% (6 patients) to 79% overall. In 32 patients staging of mediastinal lymph nodes was attempted. Positive TBNA proved inoperability in 9 patients. In 7 patients TBNA was used to investigate peripheral masses. Two patients had a malignant tumor, of which one was diagnosed by TBNA. Overall, TBNA revealed important information with clinical consequences in 16 of 72 patients (22%). There were no complications. We conclude that TBNA significantly increases the diagnostic yield of fiberoptic bronchoscopy and carries only a minimal risk. Our results, obtained in the clinical routine setting of a teaching hospital, are comparable to the reported results of controlled studies.     

Transbronchial needle aspiration of a bronchial carcinoid tumor

We biopsied a suspected bronchial carcinoid tumor with a transbronchial aspiration needle and obtained cytologic diagnosis without significant hemorrhage. This technique may prove valuable in sampling highly vascular endobronchial neoplasms.     

Transbronchial needle aspiration in the diagnosis of endobronchial malignant lesions: a 3-year experience

STUDY OBJECTIVES: To establish the diagnostic yield of transbronchial needle aspiration (TBNA) and its contribution to conventional diagnostic techniques (CDT) such as forceps biopsy, bronchial washing, and bronchial brushing in the diagnosis of malignant endobronchial lesions. DESIGN: Retrospective clinical study. PATIENTS: One hundred fifteen lung cancer patients MEASUREMENT AND RESULTS: We reviewed files of 115 lung carcinoma cases diagnosed in our clinic from 2001 to 2003 with endobronchial lesions sampled by CDT and TBNA. The lesions were classified into three groups: exophitic mass lesion (EML), submucosal disease, and peribronchial disease. The diagnostic yield of TBNA and CDT was compared to that of the combination of CDT and TBNA with respect to the type and location of the lesion and the histopathologic subgroups. Of the 115 cases, histology findings were confirmed by TBNA in 91 cases (79%), CDT in 75 cases (65%), and TBNA plus CDT in 105 cases (91%). The difference of the diagnostic yield of CDT vs TBNA plus CDT was statistically significant (p < 0.001). In peribronchial disease, the sensitivity of TBNA plus CDT was significantly better than CDT (87% vs 52%, p < 0.001). In EML and submucosal disease, addition of TBNA to CDT improved sensitivity from 85 to 100% and from 84 to 97%, respectively (p > 0.05). Regarding localization, the addition of TBNA to CDT increased sensitivity in the trachea and main bronchi, and in right upper and middle lobe lesions (p < 0.05). By the addition of TBNA to CDT, small cell lung cancer and non-small cell lung cancer cases demonstrated improvements in sensitivity from 74 to 100% and 61 to 87%, respectively. This significant difference (p < 0.05) was attributed to the peribronchial disease group. CONCLUSION: In the case of peribronchial disease, the addition of TBNA to CDT improves the diagnostic yield of the bronchoscopic examination.