Bronchoscopic Needle Aspiration Research Articles

DIAGNOSTIC EFFICACY OF BRONCHIAL WASHING CYTOLOGY AND BRONCHOSCOPIC NEEDLE ASPIRATION CYTOLOGY IN THE EVALUATION OF MASS LESIONS OF LUNGS – AN OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL.

Lung cancer is the most common cancer diagnosed worldwide. It is also the foremost contributor to cancer-related mortality, resulting in 1.38 million deaths per year worldwide. There are various diagnostic modalities for lung mass lesions including bronchial washing (BW), bronchoscopic needle aspiration (BNA) and bronchoscopic biopsy (BB). To determine sensitivit Objectives:- y (Sn), specicity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of both BW and BNA as individual test and as combined tests, taking BB results as gold standard. This was an observational cross-sectional study conducted in a tert Material and methods:- iary care hospital of this part of NorthEast India over a period of two years (July 2020 to June 2022). 55 cases of lung mass lesions underwent BW, BNA and BB during the study period & were analysed. The study found highest sensitivity in combined BNA & BW (95%), highest Result:- specicity in BNA (81%), highest PPV in BNA (95%) and highest NPV in combined BNA & BW(88%). This study concluded that BNA i Conclusion:- s a better diagnostic modality than BW and if BW is done it should always be supported with BNA which contribute to more precise diagnosis

Petals of rose: Application of rapid on-site evaluation in bronchoscopy

In present day scenario, procedures that are minimally invasive like FNAs and Core needle biopsies are on the rise. Rapid on-site evaluation (ROSE) is a laboratory service that assesses the cytomorphologic features from FNA smears or biopsy contact imprints in the biopsy room and can provide on the spot input and suggestions for the clinician through immediate cytological examination of the biopsy sample. ROSE also allows for a preliminary diagnosis, allowing for the requirement of additional material for ancillary studies. We are presenting two cases which highlights the merits of ROSE in cytological diagnosis. In the first case, a thirty four year old male patient came with complaints of productive cough, breathlessness and fever. Bronchoscopic needle aspiration and biopsy was done with Rapid Onsite Evaluation. ROSE revealed two non-caseating epithelioid granulomas on the 4th pass. Bronchoscopic lymph node biopsy was non- contributory. With other clinical and biochemical parameters, diagnosis of Sarcoidosis was made. This case study underscores the significance of ROSE in arriving at the diagnosis. In the other case, a fifty seven year old male patient came to hospital with productive cough and breathlessness (MMRC grade II). CT chest revealed features suggestive of bronchogenic carcinoma. ROSE was performed along with bronchial brush cytology in which presence of atypical cells with increased nuclear cytoplasmic ratio, nuclear hyperchromatism and nuclear molding was noted. On histopathological examination, it was diagnosed as a case of non-small cell carcinoma of lung – poorly differentiated type. This case proves the advantage of ROSE in avoiding repeated invasive procedures for the patient.

Staging and operability of primary lung cancer in Western Cape Province, South Africa.

Background Lung cancer is the leading cause of cancer-related death globally and in South Africa. Historically, the majority of patients diagnosed with lung cancer are incurable at presentation. Objectives To assess the tumour, nodes, metastasis (TNM) staging of lung cancer in a centre with access to both positron emission tomography-computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a structured diagnostic approach and to compare results with a historical cohort from 2009 from the same hospital. Methods A retrospective descriptive observational study was performed using the registry of a high-volume tertiary hospital’s weekly multidisciplinary thoracic oncology meeting (MDT). A structured diagnostic approach was used for staging purposes. All patients with a tissue diagnosis of primary lung cancer and adequate imaging (chest CT and/or PET-CT) who presented at the MDT during the period from 1 January - 31 December 2019 were included. Final staging and tissue diagnoses were documented and compared with a historical cohort from 2009 from the same institution. Results Adenocarcinoma was the most common subtype (38.8%; n=116). Less than a tenth of patients (6.3%; n=16/254) with non-small cell lung cancer had potentially curable lung cancer (stage IA to IIIA) at presentation, significantly less than the 2009 cohort (14.5%; n=25/173; p=0.007). The most common procedure administered on patients was transthoracic needle aspiration (37.54%; n=112), followed by conventional bronchoscopic needle aspiration or biopsy (20.4%; n=61), and EBUS-TBNA (17.1%; n=51/299). After PET-CT, 19/30 cases were upstaged including 9/18 from potentially resectable to unresectable. Two of these cases were down-staged to potentially resectable following EBUS-TBNA. Conclusion There was a significant decline in resectable and potentially curable lung cancer at presentation over a 10-year period. PET-CT and EBUS-TBNA improved the accuracy of non-small cell lung cancer staging among patients with resectable and potentially curable lung cancer but have exposed a higher stage profile.

Bronchoscopic needle aspiration in the diagnosis of mediastinal lymphadenopathy and staging of lung cancer

Transbronchial needle aspiration (TBNA) has the potential to allow adequate mediastinal staging of non-small cell lung cancer with enlarged lymph nodes in most patients without the need for mediastinoscopy. Metastasis to the mediastinal lymph nodes is one of the most important factors in determining resectability and prognosis in non-small cell lung cancer. The importance of TBNA as a tool for diagnosing intrathoracic lymphadenopathy as well as in the staging of lung cancer has been reported in various studies. We performed a literature search in PubMed and Journal of Bronchology using the keyword transbronchial needle aspiration. TBNA is a safe and effective procedure to diagnose mediastinal lymphadenopathy. Real-time bronchoscopic ultrasound-guided TBNA is the new kid on the block, which can further enhance the sensitivity of bronchoscopy in the diagnosis of mediastinal lesions.

Hemoptysis in a Patient with Melanoma and Pulmonary Infiltrates

An 85-year-old white man with known history of melanoma was referred to the Interventional Pulmonary service for hemoptysis. Review of recent imaging revealed nodular infiltrates without significant volume loss. Bronchoscopy was performed revealing glistening polypoid endobronchial masses obstructing the apical-posterior segment (B 1 ) of the left upper lobe and anterior segment of the right upper lobe (B) (Figure 1). Bronchoscopic needle aspiration and biopsy were performed. Argon plasma coagulation was then undertaken with successful ablation and subsequent patency of the involved segments (Figure 2). Lung metastases from malignancy other than bronchogenic carcinoma are a common occurrence with the incidence ranging from 20 to 50%.1 Although the incidence for endobronchial metastasis has been reported to be from about 2 to 28%, a retrospective review of 1359 autopsies revealed only 2% of patients dying with solid tumors to have metastatic involvement of the central airways.2 Metastases from primary malignancy are traditionally described to spread via a hematogenous or lymphatic route, however, tracheal or bronchial obstruction due to endobronchial metastasis is rare, and must be differentiated from obstruction caused by an extrinsic mass. Although frequently asymptomatic (52%), endoluminal metastasis may commonly present with cough, wheezing, dyspnea, and hemoptysis as was present in our patient. Radiographic findings may include lobar or segmental atelectasis. Endoluminal metastasis may signal slow disease progression and have a median lag time of up to 5 years or more dependent upon the underlying primary malignancy.3 Renal cell carcinoma is thought to be the most frequent etiology of endobronchial metastasis with other tumors to include melanoma, lymphoma, breast, larynx, thyroid, and colon. Primary melanoma of the airway with tracheal obstruction and diffuse melanosis of the airways without associated skin or mucous membrane pigmentation has also been described. Rare patients with bronchial obstruction associated with malignant melanoma have been reported, as was true in our patient. Appropriate diagnosis should be performed to exclude the potential of a second primary. Endobronchial biopsies are easily obtained, however, as certain tumors are noted for a propensity toward significant bleeding, such as renal cell carcinoma and melanoma, initial sampling may easily be performed by means of endoluminal needle aspiration described by Wang et al.4 Management of bronchial metastases is symptom based. Historically, if the obstructing mass could be localized by imaging studies, external beam radiotherapy, or surgery was employed to palliate the obstruction. It is currently reasonable to attempt to relieve obstruction by laser endoscopy, argon coagulation, or photodynamic therapy. Endobronchial brachytherapy has sometimes been attempted with some success although late toxicity with bronchial wall necrosis has been attributed to contact between the catheter and bronchial wall mucosa. It should be

Bronchoscopic Needle Aspiration and Biopsy of Paratracheal Tumors and Hilar and Mediastinal Lymph Nodes

Bronchoscopic needle aspiration (BNA) and biopsy is a technique that permits us to obtain cytohistologic samples of lesions adjacent to the wall of the tracheobronchial tree and the mediastinum by means of flexible needles designed for use with flexible bronchoscopy. It is not possible to reach these sites with standard techniques of biopsy and brushing. We prospectively studied 58 patients (45 men, 13 women) with paratracheal tumors and hilar and mediastinum lymph nodes, more than 1 cm in the short axis, using cytologic (MW-222) and histologic needles (MW-319), the information obtained from computed tomography (CT) before puncture, and the endoscopic reference of the map of the lymph nodes of the mediastinum. We obtained a valid sample for diagnosis in 58 (100%) patients and definite cytohistologic diagnosis in 50 (86%). BNA was the only diagnostic technique used in 36 (62%). We achieved a sensitivity of 94% and specificity of 100%. No complications were experienced. The size and aspect of the core of the biopsy obtained with the histologic needle (MW-319) were similar to those obtained with transbronchial forceps biopsy or by transthoracic aspiration biopsy of the peripheral nodules/masses with CT. In 39 patients (67%), surgical techniques (ie, mediastinoscopy) were avoided, which means a calculated savings of 119.00 dollars. Thirty-six of those 39 had only a diagnostic technique and 3 were true-negatives according to evolution. BNA is an almost noninvasive technique that is safe and economical, can be performed in ambulatory patients without general anesthesia, and avoids more invasive and costly surgical techniques. Thus, we believe that it should be included in the protocols as the first procedure for cytohistologic diagnosis of paratracheal tumors and hilar and mediastinal lymph nodes.

On-site Cytopathologic Analysis of Bronchoscopic Needle Aspiration

On-site Cytopathologic Analysis of Bronchoscopic Needle Aspiration

On-site Cytopathologic Analysis of Bronchoscopic Needle Aspiration

On-site Cytopathologic Analysis of Bronchoscopic Needle Aspiration

Pulmonary Blastomycosis: An Appraisal of Diagnostic Techniques

Pulmonary blastomycosis often mimics bacterial pneumonia or bronchogenic carcinoma, which may result in delayed therapy or the performance of unnecessary diagnostic procedures. We have reviewed the utilization of diagnostic techniques in the workup of patients with pulmonary blastomycosis, defined their diagnostic yields, and proposed an optimal diagnostic approach for the patient in whom pulmonary blastomycosis is considered. Retrospective chart review of all patients with the diagnosis of blastomycosis at a major academic medical center. Of the 119 patients with blastomycosis, 56 (47%) had pulmonary involvement. A total of 92 specimens were obtained by noninvasive means (sputa, 72 specimens; tracheal secretions, 5 specimens; and gastric washings, 15 specimens) in 35 patients. KOH smears were prepared from 22 of those specimens (24%). The diagnostic yield from these culture specimens obtained by noninvasive means was 86% per patient, and 75% per single sample. The diagnostic yields from KOH smears were 46% and 36%, respectively. Flexible bronchoscopy was performed in 24 patients and yielded a diagnosis in 22 (92%). Cultures of bronchial secretions (19 patients) and BAL fluid (6 patients) were positive in 100% and 67% of patients, respectively. The corresponding yields of KOH preparations were 17% (1 of 6 preparations) and 50% (3 of 6 preparations), respectively. Pathology specimens including those from bronchoscopic lung biopsies (nine patients), bronchial brushings (two patients), and bronchoscopic needle aspiration (one patient) were positive in 22%, 50%, and 0% of cases, respectively. Cytology was usually performed to exclude malignancy and was positive for Blastomyces dermatitidis in five patients (sputum, three patients; bronchial washings, two patients). Thoracotomy was performed in 11 cases, and in all patients the procedure yielded a diagnosis. Serology results were available in 25 patients. Immunodiffusion was positive in 10 patients (40%), and complement fixation in 4 patients (16%). In patients with pulmonary blastomycosis, the positive yield from respiratory specimen cultures is high, but the confirmation of a diagnosis may take up to 5 weeks. Wet smears and cytology examinations of respiratory specimens provide quicker diagnoses but are underutilized. Their routine use is recommended in endemic areas. Commonly used serologic assays are insensitive and are not useful for diagnostic screening.

Bronchoscopic Needle Aspiration (BNA) and Biopsy

Bronchoscopic Needle Aspiration (BNA) and Biopsy

Bronchoscopic Needle Aspiration (BNA) and Biopsy

Bronchoscopic Needle Aspiration (BNA) and Biopsy

Increasing Use of Bronchoscopic Needle Aspiration to Diagnose Small Cell Lung Cancer

To review pathology reports to determine whether a temporal change in diagnostic procedures that included bronchoscopic needle aspiration (BNA) in evaluation of small cell lung cancer (SCLC) had occurred. A retrospective review of the computerized pathology database of the Wake Forest University Baptist Medical Center from 1990 to 1998 was performed. All pathology reports of patients newly diagnosed with SCLC were reviewed and abstracted. The number of patients newly diagnosed with SCLC during the 9-year study period totaled 277. Of these, 173 underwent bronchoscopy. From January 1990 to December 1991, 32% (8/25) of bronchoscopies done in patients with SCLC included BNA compared with 81% (120/148) (P < .001) from January 1992 to December 1998. In addition to the increased use of BNA in patients with SCLC undergoing bronchoscopy, the overall diagnostic yield for BNA in SCLC significantly increased over the 9-year study period from 50% (4/8) in 1990 and 1991 to 88% (106/120) thereafter (P = .001). Overall sensitivity of BNA during bronchoscopy was 86% for SCLC with only a small increase in sensitivity with use of all procedures (including BNA) to 91%. The use of forceps biopsy and bronchial brushings decreased over this period. With progressive experience with BNA, the frequency of its performance and its diagnostic yield in patients with SCLC increased markedly. The SCLC yield may be a worthwhile marker of BNA program development.

Bronchoscopic needle aspiration biopsy.

Bronchoscopic needle aspiration biopsy, which encompasses transbronchial needle aspiration, transtracheal needle aspiration, and endobronchial needle aspiration, is a minimally invasive technique used to diagnose mediastinal and pulmonary masses and to stage lung cancer patients with mediastinal lymphadenopathy. Since it is safe, accurate, and potentially cost-efficient, its use may increase in the coming years. It is important that pathologists who examine cytology specimens understand this procedure, its limitations, and ways that it may be optimized.

Advances in Bronchoscopic Procedures

Bronchoscopy is currently the most commonly employed invasive procedure in the practice of pulmonary medicine. Both the rigid and flexible bronchoscopes are used to diagnose and treat various pulmonary disorders. The main diagnostic indications include pulmonary involvement by neoplasms, infections, diffuse lung diseases, and airway problems. Bronchoscopic needle aspiration remains an underutilized technique in the staging of lung cancer. Newer techniques such as bronchoscopic ultrasound appear promising and may lead to improved diagnostic yield from bronchoscopic procedures. The bronchoscope is used in application of laser therapy, brachytherapy, electrocautery, cryotherapy, placement of airway stents, and balloon dilatation to relieve airway obstruction caused by malignant and benign airway lesions.

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

Bronchoscopic Needle Aspiration in Mediastinal Staging of Patients with Bronchogenic Carcinoma

Seventy-six patients (mean age. 64 years) with chest radiographs suggestive of lung cancer and with evidence of mediastinal adenopathy on computed tomography (CT) underwent bronchoscopy with bronchoscopic needle aspiration (BNA) of the affected mediastinal nodes. Patients with meta-static disease or other findings suggesting nonresectability were excluded from the study. Cytologic examination of BNA was positive for malignancy in 72% of patients (55/76). BNA of subcarinal nodes was positive in 74% of patients (41/55), and BNA of paratracheal nodes was positive in 67% of patients (14/21). BNA was positive in 82% of patients (49/56) whose main carina or trachea appeared abnormal on bronchoscopy, and was positive in 45% of patients (9/20) who, under bronchoscopic examination, had a normal main carina and trachea. Of 21 patients with negative BNA cytology, 10 patients had nonsmall-cell carcinoma. Those individuals underwent further surgical staging, establishing that eight aspirates were false negative and two aspirates were true negative. The sensitivity of BNA in patients with nonsmall-cell carcinoma was 78%, considering all positive aspirates as true positive. No serious complications were observed. In conclusion, BNA of the mediastinal nodes is a safe and valuable staging procedure in patients with lung cancer and evidence of mediastinal adenopathy on chest CT.

Mechanism of Pneumothorax after Bronchoscopic Needle Aspiration

Mechanism of Pneumothorax after Bronchoscopic Needle Aspiration

Bronchoscopic Needle Aspiration in Patients with Superior Vena Caval Disease

Abstract: Flexible bronchoscopy (FFB) with bronchoscopic needle aspiration (BNA) has been a valuable procedure for diagnosing and staging patients with lung cancer. Although anecdotal observations have suggested this procedure is a safe, effective means for evaluating persons with superior vena cava (SVC) involvement, its diagnostic yield and safety in this clinical setting have not been clearly established. To assess this application of BNA, we reviewed our experience in patients who underwent BNA during diagnosis and/or staging. Fifteen patients with SVC compression and/or occlusion underwent BNA. The procedure was diagnostic in 10 (67%) patients, whose diagnoses included large cell carcinoma (4 patients), small cell carcinoma (3), poorly differentiated carcinoma (2), and adenocarcinoma (I). There were no airway complications. Significant bleeding leading to termination of bronchoscopy occurred in only two patients (13%). Diagnostic BNA results permitted timely initiation of palliative therapy in all patients. Because of its yield, safety, and impact on management, we believe that BNA is the preferred minimally invasive mode of diagnosis in patients with SVC involvement by lung cancer.

320 Bronchoscopic needle aspiration (BNA) in the staging of lung cancer

320 Bronchoscopic needle aspiration (BNA) in the staging of lung cancer