Usefulness Of Transbronchial Needle Aspiration Research Articles

Usefulness of Transbronchial Needle Aspiration Through a Guide Sheath Using the PeriView FLEX Device in Addition to Endobronchial Ultrasonography with a Guide Sheath Transbronchial Biopsy for the Diagnosis of Pulmonary Actinomycosis

Usefulness of Transbronchial Needle Aspiration Through a Guide Sheath Using the PeriView FLEX Device in Addition to Endobronchial Ultrasonography with a Guide Sheath Transbronchial Biopsy for the Diagnosis of Pulmonary Actinomycosis

Utility of Image Guided Fine Needle Aspiration Cytology in Intra-Thoracic Lesions with Emphasis on Lung Cancer Detection.

Background and Aims:Fine Needle aspiration cytology has emerged as an essential pre-biopsy investigation to rule out or confirm malignancy in superficial as well as deep seated lesions. Radiological assistance has proved to be a blessing for obtaining adequate samples. With unwavering leading position of lung cancer in terms of incidence and mortality, it has become necessary to study the trends of our population and assess the usefulness of techniques aiding in early diagnosis. The objective is to obtain prevalence of lung cancer and utility of various methods in obtaining cytological material for assessment in intrathoracic lesions.Material and Methods:We conducted an observational analytic study at a tertiary care teaching hospital over a period of 3.5 years including a total of 307 patients with suspected lung malignancy. Samples were collected using image guided techniques including Fibre-optic bronchoscopy (FOB), Ultra-sonography (USG) and Computed tomography (CT). The smears were processed as per standard institutional protocol and were evaluated by a senior pathologist.Results:Squamous cell carcinoma was the most frequent type of Primary lung malignancy, followed by adenocarcinoma. The malignancies were more common in males and in age group of 61 to 70 years.Conclusion:Respiratory cytology remains the initial mode of investigation in intra-thoracic malignancies. The high sensitivity, low-cost and rapidity of the results works its advantages for both the patient and the clinician. High cellular yield obtained with the use of trans-bronchial needle aspiration and bronchial brushing rationalizes their use as a screening test to establish both malignant as well as non-malignant diagnoses. Further improvement in utilization of the available modalities and addition of ancillary testing can reduce the need of invasive procedures.

Comparative Analysis for Diagnostic Yield of Small Cell Lung Cancer by Cytology and Histology During the Same Bronchoscopic Procedure

BackgroundBiopsy, brushing, and transbronchial needle aspiration (TBNA) are the most common methods used for the diagnosis of small cell lung cancer during the same diagnostic bronchoscopic procedure. However, it is not clear which method provides better results. Patients and MethodsA retrospective analysis was performed of 140 patients who had undergone video bronchoscopy for diagnostic purposes. Bronchial brushings were obtained from all subjects. Biopsy specimens were also obtained from all subjects, except for 6 cases that could not be sampled; the TBNA method was used for some special lesions. The results were analyzed separately by histology and cytology. ResultsThe diagnostic yield of cytology was significantly greater than that of histology (P < .01) and that of conventional smear preparations in cytology was obviously greater than that of hematoxylin and eosin stains in histology (P < .01). The false-negative results were significantly lower with cytology than with histology (P < .01). Also, the cases of sampling site restriction with cytology were distinctly less than those with histology (P < .05). Stretch deformation of the tissue structure and cell morphology was the main reason for the false-negative results in the histologic diagnosis. The use of TBNA resolved all 4 cases of hilar adenopathy and 2 cases of lesions outside the bronchus. Multiple brushings of the tissue adjacent to cancer tissue and liquid-based preparations of cancerous necrotic tissue can significantly reduce the false-negative results from biopsy. ConclusionsThe diagnostic yield of cytologic examination of brushings and TBNA for small cell lung cancer was superior to that of histologic examination of hematoxylin and eosin stains and immunohistochemistry.

‘Bronchoscopic Characterization of Lesions’: Significant impact on lung cancer diagnosis with use of Transbronchial needle aspiration (TBNA) in Comparison to conventional diagnostic techniques (CDTs)

Background: Lung Cancer is the leading cause of cancer deaths around the world. Lung cancer accounts for 13.8% of all cancer diagnosis in India. Aims: (1) To find the role of bronchoscopic characterization of lesions and its impact on outcome in yield in lung cancer with use of conventional diagnostic techniques. (2) To observe additional yield of transbronchial needle aspiration (TBNA) in comparison to other conventional diagnostic techniques (CDTs) such as bronchial wash (BW), bronchial brush (BB), and forcep biopsy. Settings and Design: This is a prospective muticentric study conducted during June 2013–December 2016 at bronchoscopy unit of Venkatesh Chest Hospital Latur and Pulmonary Medicine, MIMSR Medical College Latur India. Materials and Methods: The study included 210 patients on the basis of clinical and radiological features of malignancy after inclusion and exclusion criteria and institutional review board approval. Fiberoptic bronchoscopic abnormalities were categorized as Exophytic endobronchial lesions, submucosal lesions, peribronchial lesions, and no abnormality. TBNA and other CDTs such as forcep biopsy, BB, and BW were performed during bronchoscopy procedure. Histopathological and cytological examinations of specimens were performed at pathology department. Statistical Analysis Used: The statistical analysis was done using Chi-square test. Results: In exophytic endobronchial lesions, yield of TBNA, CDTs, and TBNA plus CDTs was 62.60%, 79.67%, and 84.55%, respectively (P 0.8). In peribronchial lesions, TBNA has significant yield, i.e., 63.41% individually as compared to forcep biopsy 26.82% and CDT 39.02% (P < 0.001). Overall diagnostic yield of fiberoptic bronchoscopy in confirming the diagnosis was 71.95%. Conclusions: Bronchoscopic characterization of lesions and use of technique accordingly during bronchoscopy has a significant outcome in the form of yield also it will decrease the need for repeat bronchoscopy.

Endobronchial Ultrasound-Guided Cautery-Assisted Transbronchial Forceps Biopsies: Safety and Sensitivity Relative to Transbronchial Needle Aspiration

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is important in the evaluation of thoracic lymphadenopathy. Reliably providing excellent diagnostic yield for malignancy, its diagnosis of sarcoidosis is inconsistent. Furthermore, TBNA may not suffice when larger "core biopsy" samples of malignant tissue are required. The primary objective of this study was to determine if the sequential use of TBNA and a novel technique called cautery-assisted transbronchial forceps biopsy (ca-TBFB) was safe. Secondary outcomes included sensitivity and successful acquisition of tissue. The study prospectively enrolled 50 unselected patients undergoing convex-probe EBUS. All lymph nodes exceeding 1 cm were sequentially biopsied under EBUS guidance using TBNA and ca-TBFB. Safety and sensitivity were assessed at the nodal level for 111 nodes. Results of each technique were also reported for each patient. There were no significant adverse events. In nodes determined to be malignant, TBNA provided higher sensitivity (100%) than ca-TBFB (78%). However, among nodes with granulomatous inflammation, ca-TBFB exhibited higher sensitivity (90%) than TBNA (33%). On the one hand, for analysis based on patients rather than nodes, 6 of the 31 patients with malignancy would have been missed or understaged if the diagnosis were based on samples obtained by ca-TBFB. On the other hand, 3 of 8 patients with sarcoidosis would have been missed if analysis were based only on TBNA samples. In some patients, only ca-TBFB acquired sufficient tissue for the core samples needed in clinical trials of malignancy. The sequential use of TBNA and ca-TBFB appears to be safe. The larger samples obtained from ca-TBFB increased its sensitivity to detect granulomatous disease and provided adequate specimens for clinical trials of malignancy when specimens from needle biopsies were insufficient. For thoracic surgeons and advanced bronchoscopists, we advocate ca-TBFB as an alternative to TBNA in select clinical scenarios.

Determinants of Practice Patterns and Quality Gaps in Lung Cancer Staging and Diagnosis

Guidelines recommend mediastinal lymph node sampling as the fi rst invasive diagnostic procedure in patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases. Patients were a retrospective cohort of 15,316 patients with lung cancer with regional spread without metastatic disease in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) or Texas Cancer Registry Medicare-linked databases. Patients were categorized based on the sequencing of invasive diagnostic tests performed: (1) evaluation consistent with guidelines, mediastinal sampling done fi rst; (2) evaluation inconsistent with guidelines, non-small cell lung cancer (NSCLC) present, mediastinal sampling performed but not as part of the fi rst invasive test; (3) evaluation inconsistent with guidelines, NSCLC present, mediastinal sampling never done; and (4) evaluation inconsistent with guidelines, small cell lung cancer. The primary outcome was whether guideline-consistent care was delivered. Secondary outcomes included whether patients with NSCLC ever had mediastinal sampling and use of transbronchial needle aspiration (TBNA) among pulmonologists. Only 21% of patients had a diagnostic evaluation consistent with guidelines. Only 56% of patients with NSCLC had mediastinal sampling prior to treatment. There was significant regional variability in guideline-consistent care (range, 12%-29%). Guideline-consistent care was associated with lower patient age, metropolitan areas, and if the physician ordering or performing the test was male, trained in the United States, had seen more patients with lung cancer, and was a pulmonologist or thoracic surgeon who had graduated more recently. More recent pulmonary graduates were also more likely to perform TBNA ( P < .001). Guideline-consistent care varied regionally and was associated with physician-level factors, suggesting that a lack of effective physician training may be contributing to the quality gaps observed.

The diagnostic value and safety of transbronchial needle aspiration biopsy in children with mediastinal lymphadenopathy

Anterior mediastinal masses in children can have different causes which includes, Mycobacterium tuberculosis (MTB) or malignant lymphadenopathy. Transbronchial needle aspiration (TBNA) has been described as a safe and effective diagnostic procedure in adult patients with lung cancer. To describe the use of TBNA as a diagnostic test in children with large subcarinal lymphadenopathy and to determine the safety of the procedure in children. Prospective descriptive study of children with subcarinal mediastinal lymph nodes who underwent TBNA. The majority of the children were referred due to treatment failure. Children were enrolled if the diagnosis remained unclear after computer tomography of the chest. Thirty patients were enrolled in this study; TBNA was done in 28 patients. A definitive diagnosis was made by TBNA in 54% (n = 15) of patients; MTB lymphadenopathy (n = 13), metastatic nephroblastoma (n = 1), and fibrosing mediastinitis (n = 1). In seven (25%) cases the TBNA was the sole source of the specimens from which the definitive diagnosis was made. No serious complications were encountered during or after the procedure. TBNA is a safe procedure in children with mediastinal lymphadenopathy of unknown cause resulting in a definitive diagnosis in 57% of cases. TBNA adds additional value to flexible bronchoscopy in the diagnosis of mediastinal lymphadenopathy in children.

Improving standards in flexible bronchoscopy for lung cancer

Can the detection rate of flexible bronchoscopy for lung cancer be increased by a series of simple quality improvement measures? Bronchoscopy-associated clinical parameters were prospectively recorded between 2001 and 2007 in patients with suspected lung malignancy. The detection rate of bronchoscopy, diagnostic yield of each biopsy modality and the possible impact of different service-improvement measures were assessed. 746 bronchoscopies were performed in 704 patients. The detection rate of bronchoscopy for malignancy was 83.6%, and increased over time (67.3% detection rate in 2001 (95% CI 52.9-79.7), 89.7% detection rate in 2007 (95% CI 81.3-95.2); p<0.001). Detection rate increased for bronchoscopically visible (75.0% in 2001 to 94.5% in 2007) and non-visible tumours (41.7% in 2001 to 81.2% in 2007; p<0.001 for both analyses). Prior computed tomography availability was associated with a higher diagnostic yield that did not reach statistical significance. Logistic regression analysis identified tumour visibility, year of study, use of transbronchial needle aspiration and pathologist identity as independent predictors of a positive diagnosis. A significant increase in bronchoscopic detection rate for malignancy occurred in association with a number of simple improvement measures.

Usefulness of transbronchial needle aspiration for initial lung cancer staging

Besides radio logical methods (especially positron emission tomography combined with computed tomography), endoscopic techniques including transbronchial needle aspiration (TBNA) of mediastinal lymph nodes play an important role in lung cancer staging, thus having a significant effect on further patient management. The aim of the study was to investigate the diagnostic value of blind TBNA in staging of lung cancer, using systematic mediastinal lymph node dissection (SLND) at thoracotomy as a confirmatory test. Patients with lung cancer and enlarged mediastinal lymph nodes on computed tomography scans underwent TBNA. Non-small cell lung cancer (NSCLC) patients with negative TBNA or with single-level N2 disease underwent thoracotomy with appropriate pulmonary resection and with SLND. In 84 lung cancer patients, 166 TBNA were performed. Metastatic lymph node involvement was identified in 57 patients (67.9%). There were 10 patients (11.9%) with small cell lung cancer. Of the 74 NSCLC patients, TBNA revealed meta stases in 48 (64.9%). Twenty-four TBNA-negative patients (32.4%) and 4 patients (5.4%) with single-level N2 disease underwent pulmonary resection with SLND. In 8 of 28 operated patients (28.6%), N2 meta static nodes were identified. The per-patient analysis showed the sensitivity of TBNA to be 81.5%, specificity - 100%, accuracy - 86.5%, and negative predictive value (NPV) - 66.7%. Our results suggest that TBNA may be a useful method for initial NSCLC staging in patients suspected of N2-3 disease. Positive TBNA in 1 station only should not be considered as a true single-level N2 disease, because of a relatively low NPV for TBNA.

TRANSBRONCHIAL NEEDLE ASPIRATION IN HIV-INFECTED PATIENTS WITH INTRATHORACIC ADENOPATHY: A 15-YEAR EXPERIENCE AT A MAJOR TEACHING HOSPITAL

PURPOSE: We reported our initial experience with transbronchial needle aspiration (TBNA) in the HIV-infected patient in 1998 and 1999. This abstract reviews our 15-year experience in the use of transbronchial needle aspiration (TBNA) as the initial invasive diagnostic procedure in HIV-infected patients with intrathoracic adenopathy at Bellevue Hospital Center. AJRCCM 1998;157:1913-1918. Chest 1999;116:S257-258.

Diagnostic Yield of Transbronchial Histology Needle Aspiration in Patients with Mediastinal Lymph Node Enlargement

Background: Transbronchial needle aspiration (TBNA) is a safe, minimally invasive technique to assess the mediastinal spread of lung cancer. Excellent results have been published by experts. However, little information is available about the diagnostic yield of TBNA with the histology needle in a non-expert center. Objectives: The aim of this study is to assess the diagnostic yield of histology TBNA in the workup of suspected lung cancer. Methods: In a non-university teaching hospital, TBNA data from patients diagnosed with lung cancer between June 1998 and July 2000 were analyzed retrospectively. TBNA had been performed by six different bronchoscopists in patients eligible for surgery with accessible N2 and N3 lymph nodes on computed tomography of the chest during the workup of an undefined mass. Cytology and histology specimens were obtained with the same 19-gauge needle. TBNA results were considered to be diagnostic if cytologic or histologic examination revealed a malignant lesion or non-malignant lymphoid cells. However, TBNA outcome was called non-diagnostic if no representative cells were obtained. Results: From a group of 264 consecutive lung cancer patients, 106 (40%) patients were eligible for TBNA. In 79%, TBNA was diagnostic in cytology and/or histology specimens. Malignancy was demonstrated in 59% (63/106). In only 32/106 patients (30%), a histologic core of tissue could be sampled. In 87.5% of these patients (28/32), TBNA was diagnostic. For cytology only, this number was slightly lower (75%, 56/74). In 12 cases, diagnostic TBNA was verified by mediastinoscopy: these diagnoses were concordant. The sensitivity is 65% if all non-confirmed cases are considered false negative. Ten mediastinoscopies were avoided because TBNA demonstrated contralateral N2 (= N3) disease. The routine use of TBNA during bronchoscopy in suspected N2 disease is a cost-effective procedure, as the total additional costs of TBNA (9,540 EUR) were lower than the costs of 10 avoided mediastinoscopies (15,500 EUR). No complications were observed. Conclusion: The diagnostic yield of TBNA relied mainly on cytology specimens, despite the use of a histology needle. Representative histology specimens could only be obtained in 28/106 patients (26%). Since TBNA was performed in a general hospital by different bronchoscopists, this procedure is useful in the workup of lung cancer patients with enlarged lymph nodes.

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.

The Value of Transbronchial Needle Aspiration in the Diagnosis of Peripheral Pulmonary Lesions

Transbronchial needle aspiration (TBNA) is a bronchoscopic sampling technique used for the diagnostic workup of mediastinal lymph nodes, but the value of its routine use in evaluating peripheral pulmonary lesions is not yet firmly established. Retrospective analysis of routine diagnostic bronchoscopies. University teaching hospital. One hundred seventy-two consecutive patients (126 with malignant and 46 with nonmalignant disease) who underwent bronchoscopy for a peripheral pulmonary lesion. In 87 patients (51%), a final diagnosis was established by bronchoscopy; diagnoses included 81 malignant lesions (69 lung cancer and 12 pulmonary metastases) and 6 benign lesions (all tuberculosis). TBNA was used in 152 of the 172 patients (89%). Other endoscopic techniques included bronchial washing (100%), bronchial brushing (45%), and transbronchial biopsy (TBB) (27%). Concerning the different bronchoscopic sampling techniques, TBNA showed a positive result in 35% of cases, in comparison to 17% for TBB, 22% for bronchial washing, and 30% for bronchial brushing. While TBNA was diagnostic in 27.5% of the malignant lesions < 3 cm in diameter, the success rate in lesions > 3 cm was 65.5% (p = 0.03). Endoscopy-related complications included pneumothorax (n = 1), self-limiting bleeding (n = 12), prolonged coughing (n = 2), and vasovagal reactions (n = 2). None of these complications required further treatment. TBNA is an effective bronchoscopic sampling technique in the diagnosis of peripheral pulmonary lesions. In our study, the use of TBNA increased the diagnostic yield of bronchoscopy from 35 to 51% without additional risk. The use of TBNA in the clinical routine should be encouraged.

Utility of Transbronchial Needle Aspiration in the Diagnosis of Endobronchial Lesions

The utility of transbronchial needle aspiration (TBNA) in visible endobronchial lesions presenting as either an exophytic mass lesion (EML) or submucosal and peribronchial disease (SPD) is not well established. To compare the yield of conventional diagnostic procedures (CDP) (bronchial washing, bronchial brushing, and endobronchial forceps biopsy) with that obtained from a combination of CDP and TBNA (CDP + TBNA). Prospective study of 55 patients. Tertiary-care referral hospital. Of the 55 patients in whom malignancy was confirmed, CDP + TBNA identified 53 (96%) vs 42 (76%) identified by CDP (p = 0.001). The highest yield from any individual procedure was obtained by TBNA. Of the 23 patients with SPD, 22 (96%) were diagnosed using CDP + TBNA compared with 15 (65%) by CDP (p = 0.016); the yield from TBNA alone (22 of 23) in this group surpassed the combined yield from all other procedures. Although no statistically significant difference in yield was observed for EML, the use of TBNA identified four additional patients compared with CDP. We conclude that the addition of TBNA to CDP increases diagnostic yield in patients with visible endobronchial lesions.

Transbronchial needle aspiration (TBNA) in patients infected with HIV

Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes has been shown to be useful in the diagnosis and staging of bronchogenic carcinoma. With the exception of sarcoidosis, the usefulness of TBNA has not been widely investigated in other clinical settings. We investigated the utility of TBNA with a 19-gauge histology needle in HIV-infected patients with mediastinal and hilar adenopathy at Bellevue Hospital Center. We performed 44 procedures in 41 patients. Adequate lymph node sampling was obtained in 35 of 44 (80%), and diagnostic material was obtained in 23 of 44 (52%) procedures. TBNA was the exclusive means of diagnosis in 13 of 41 (32%) patients. Of the 44 procedures, 23 (52%) were performed in patients with mycobacterial disease, with TBNA providing the diagnosis in 20 of 23 (87%). In these patients, positive TBNA specimens included smears of aspirated materials for acid-fast bacilli in 11, mycobacterial culture in 14, and histology in 15. In other diseases, TBNA diagnosed sarcoidosis with noncaseating granulomata in 2 of 4 patients and non-small cell lung cancer in 1 of 2 patients. TBNA was not helpful in other diseases including Pneumocystis carinii pneumonia, infection with Cryptococcus or Nocardia, bacterial pneumonia, viral pneumonia, and Kaposi's sarcoma. No pulmonary diagnosis was established in five patients. No complications of TBNA occurred. We conclude that TBNA through the flexible bronchoscope is safe and effective in the diagnosis of intrathoracic adenopathy in HIV-infected patients, and is particularly efficacious in the diagnosis of mycobacterial disease. Furthermore, TBNA may provide the only diagnostic specimen in almost one-third of HIV-infected patients, thereby sparing these patients more invasive procedures such as mediastinoscopy.

Transbronchial needle aspiration (TBNA) in patients infected with HIV.

Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes has been shown to be useful in the diagnosis and staging of bronchogenic carcinoma. With the exception of sarcoidosis, the usefulness of TBNA has not been widely investigated in other clinical settings. We investigated the utility of TBNA with a 19-gauge histology needle in HIV-infected patients with mediastinal and hilar adenopathy at Bellevue Hospital Center. We performed 44 procedures in 41 patients. Adequate lymph node sampling was obtained in 35 of 44 (80%), and diagnostic material was obtained in 23 of 44 (52%) procedures. TBNA was the exclusive means of diagnosis in 13 of 41 (32%) patients. Of the 44 procedures, 23 (52%) were performed in patients with mycobacterial disease, with TBNA providing the diagnosis in 20 of 23 (87%). In these patients, positive TBNA specimens included smears of aspirated materials for acid-fast bacilli in 11, mycobacterial culture in 14, and histology in 15. In other diseases, TBNA diagnosed sarcoidosis with noncaseating granulomata in 2 of 4 patients and non-small cell lung cancer in 1 of 2 patients. TBNA was not helpful in other diseases including Pneumocystis carinii pneumonia, infection with Cryptococcus or Nocardia, bacterial pneumonia, viral pneumonia, and Kaposi's sarcoma. No pulmonary diagnosis was established in five patients. No complications of TBNA occurred. We conclude that TBNA through the flexible bronchoscope is safe and effective in the diagnosis of intrathoracic adenopathy in HIV-infected patients, and is particularly efficacious in the diagnosis of mycobacterial disease. Furthermore, TBNA may provide the only diagnostic specimen in almost one-third of HIV-infected patients, thereby sparing these patients more invasive procedures such as mediastinoscopy.