Applicability of TBNA to peripheral lung lesion when transbronchial biopsy fails

Abstract

Transbronchial needle aspiration (TBNA) has been found to improve the diagnostic yield in peripheral cancer. TBNA can be diagnostic even when transbronchial biopsy (TBB) has failed. We conducted a prospective study in 40 patients with peripheral nodular lesions from Jan 2011 to Aug 2015. TBNA was tried when an initial TBB approached the lesion but failed to target it adequately or TBB specimens were poor. TBB was tried again when TBB became possible after TBNA. TBB was done in 259 cases. TBNA was tried in 40 cases (15.4%). TBNA alone was confirmative in 25 cases (62.5%). Initial TBB approached the lesion but failed to target in 24 cases. In 12 of these cases, TBNA targeted the lesion and was confirmative in 11. In the remaining 12 cases, TBB was possible after TBNA. Five were confirmed with TBNA alone, and 3 were confirmed with TBB. Bronchostenosis was found in 5 cases, of which 4 were confirmed with TBNA alone. TBNA alone was confirmative in 3 cases with necrosis, in 1 of 3 with a hard consistency, and in 1 of 3 with massive bleeding. Regarding lung cancer (n=11), 7 cases were near targeting. In 3 of these, TBNA targeted the lesion and was confirmative in 2. In the remaining 4 cases of TBB after TBNA, 3 were confirmed with TBNA only. In patients with tuberculosis (n=14), 10 were near targeting. In 5 of these, all was confirmed by TBNA only. In the remaining 5 cases of TBB after TBNA, 2 were confirmed by TBNA alone. There was no significant difference in the diagnostic yield of TBNA according to the lesion size or location. In conclusion, we would recommend trying TBNA when TBB fails, but approaches near the lesion. The diagnostic yield of TBNA was not influenced by the size or location of the lesion.