Transbronchial Needle Aspiration of Hilar and Mediastinal Lymph Nodes:

Abstract

Besides clarifying the etiology of unidentified lymphadenomegaly, puncturing hilar and mediastinal lymph nodes by a flexible bronchoscopic needle is an aid in diagnosing and staging bronchogenic cancer or other metastatic cancers. In this study we investigated whether rapid on-site staining and the presence of a cytopathologist improves the effectiveness of transbronchoscopic needle aspiration (TBNA). For 31 months, from April 2001 onward, we performed TBNA in 139 patients to clarify the central lesion. In case of negative CT, no examination was carried out. Puncture was performed only upon availability of pathologically enlarged lymph nodes displayed by CT. A parallel TBNA examination was not conducted in case of a visible intrabronchial tumor. During rapid staining, the ability to assess and the adequacy of the sample had to be judged. In our lung cancer patients, sensitivity in reference to malignancy was 89.8% and specificity was 100%. In our own material, examinations in cases of a wider carina or a normal endobronchial picture yielded similar results (45 of 51 patients, 88.2% vs. 35 of 38 patients, 92.1%). In our small-size material of stage I and stage II sarcoidosis, the cytologic picture provided diagnosis in 81% of the patients (22 of 27). In the other benign cases, however, the cytologic pattern revealed by TBNA was uninformative. Rapid on-site staining has increased the success rate of TBNA and, as a result, its diagnostic value has also improved.