Transbronchial needle aspiration "by the books"

Abstract

Background: Training for advanced bronchoscopic procedures is acquired during the interventional pulmonology (IP) Fellowship. Unfortunately a number of such programs are small, limiting dissemination of formal training.

Objective: We studied success of conventional transbronchial needle aspiration (C-TBNA) in the hands of physicians without formal IP training.

Methods: A technique of C-TBNA was learned solely from the literature, videos and practicing on inanimate models at "Hands-On" courses. Conventional TBNA with 21 and/or 19 gauge Smooth Shot Needles (Olympus(®), Japan) was performed on consecutive patients with undiagnosed mediastinal lymphadenopathy.

Results: Thirty-four patients (male 23), mean age 54.9 ± 11.8 years underwent C-TBNA. Twenty-two patients had nodes larger than 20 mms. Suspected diagnoses were malignancy in 20 and nonmalignant conditions in 14. Final diagnoses were malignancy 17, sarcoidosis 4, reactive lymph nodes 12, and tuberculosis 1. Final diagnosis was established by C-TBNA in 14 (11 malignancy, 3 sarcoidosis; yield 41.1%), mediastinoscopy in 14, transthoracic needle aspiration in 3, peripheral lymph node biopsies in 2 and by endobronchial biopsy in 1. Nodal size had an impact on outcome (P = 0.000) while location did not (P = 0.33). C-TBNA was positive in 11/20 when malignancy was suspected (yield 55%), while 3/14 when benign diagnosis was suspected (yield 21.4%) (P = 0.05). Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 66.6%, 100%, 100%, 65%, and 79.4%, respectively. There were no complications or scope damage.

Conclusion: Conventional-TBNA can be learned by the books and by practicing on inanimate models without formal training and results similar to those published in the literature could be achieved.

Keywords: Bronchoscopy; lung cancer; mediastinal lymphadenopathy; sarcoidosis; transbronchial-needle aspiration.

Figure 1

Adenocarcinomatous cells in the three-dimensional papillary group with vesicular nuclei, prominent nucleoli, and large amount of cytoplasm; Papanicolau stain, ×200

Figure 2

Small cell carcinoma: Hyperchromatic group of cells showing apoptosis, high nucleo-cytoplasmic ratio, and nuclear molding. Neoplastic cells do not show nucleoli; Papanicolau stain, ×200

Figure 3

A large granuloma consisting of epitelioid histiocytes, few multinucleated giant cells, and lymphocytes; H and E, ×200

Figure 4

Benign reactive lymphocytes; H and E, ×100