Yield Of Transbronchial Needle Aspiration Research Articles

Transbronchial Needle Aspiration with Rapid On-site Evaluation: A Prospective Study on Efficacy, Feasibility and Cost Effectiveness

Transbronchial needle aspiration (TBNA) has an established role in diagnosis of hilar and mediastinal lesions. Rapid on-site evaluation (ROSE) of TBNA smears can determine the adequacy of TBNA smears that can obviate the need for repeat procedures, thus avoiding added cost. There is paucity of data from India showing efficacy and cost-effectiveness of ROSE. Hence, this study was carried out to assess the efficacy, feasibility and cost implications of ROSE assisted TBNA. Forty consecutive patients undergoing TBNA were enrolled and ROSE was performed on TBNA smears. The results were analysed using a comparative study design. It was found that 45% of patients would have required a repeat bronchoscopy due to inadequacy of material, if ROSE was not used. Inadequate smears were more common in benign aetiologies than malignant ones. TBNA of mass lesions and lesions with endoluminal bulge give better results than TBNA of lymph nodes and without endoluminal bulge. ROSE was found to increase the yield of TBNA and help to prevent repeat procedures. It proved to be simple, cost-effective and feasible in Indian settings.

AN UNUSUAL PRESENTATION OF MALIGNANCY

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Hodgkin’s Lymphoma (HL) is a common malignancy in adolescence and usually presents as lymph node enlargement or a mediastinal mass on imaging. We present a case of a 19-year-old male, who presented with cavitary lung lesions. He underwent multiple invasive tests and a prolonged antibiotic course only to be diagnosed with HL after undergoing a bi-lobectomy. CASE PRESENTATION: A 19-year-old male with a history of cavitary lung lesion presented to the hospital complaining of a chronic cough, fatigue and a thirty-pound weight loss in the past six months. A computed tomography (CT) of chest, on admission, showed a large cavitary lesion (6.7 by 5.6 cm) in the right upper lobe, numerous additional cavitary areas scattered in the right upper and left lower lobe along with mediastinal adenopathy (Figure 1,2). In the past, he had undergone an unremarkable infectious workup, two bronchoscopies and six weeks of antibiotics. Repeat infectious workup including blood cultures, quantiferon gold and acid fast stain came back negative. A transthoracic followed by a transesophageal echocardiogram was negative for endocarditis. Rheumatologic workup showed positive Antinuclear Antibodies with negative reflex, negative cryoglobulins, and rheumatoid factor with normal complements and serum electrophoresis. Due to worsening symptoms he underwent a third bronchoscopy with endobronchial ultrasound guided needle aspiration (EBUS-TBNA) of lymph nodes. The cultures came back negative for bacterial or fungal growth and the lymph node biopsy was negative for malignancy. Due to failure to improve, the patient finally underwent a right upper and middle bi-lobectomy. Surgical pathology came back positive for HL. He was diagnosed with Stage 3B malignancy and is currently undergoing chemotherapy. DISCUSSION: HL usually presents as a mediastinal mass and is diagnosed via lymph node biopsy. If there is pulmonary involvement, typical appearance consists of irregular pulmonary nodules as opposed to cavitary lesions 1.Our patient underwent three negative bronchoscopies and one EBUS-TBNA. This case highlights that bronchoscopies even when employed with EBUS-TBNA have high specificity (90-100%) but low sensitivities (33-66%) in diagnosing lymphomas 2,3. In these cases, consideration should be made to either repeat lymph node biopsy, or to biopsy multiple lymph nodes to help prevent unnecessary testing. CONCLUSIONS: Since HL is a common lymphoma in adolescent age group, it should be high on the differential even with a negative lymph node biopsy. Our case demonstrates an unusual pulmonary presentation of HL and highlights the importance of considering it in the differential to aid in timely diagnosis and management. Reference #1: Diederich S, Link T, Zühlsdorf H, Steinmeyer E, Wormanns D, Heindel W. Pulmonary manifestations of Hodgkin's disease: radiographic and CT findings. European radiology. 2001;11(11):2295-2305 Reference #2: Labarca G, Sierra-Ruiz M, Kheir F, et al. Diagnostic Accuracy of Endobronchial Ultrasound Transbronchial Needle Aspiration in Lymphoma. A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society. 2019;16(11):1432-1439 Reference #3: Sonnekus B. Diagnostic yield of transbronchial needle aspiration for lymphona. African Journal of Thoracic and Critical Care Medicine. 2016;22(3 ):67. DISCLOSURES: No relevant relationships by Kourtney Erickson, source=Admin input No relevant relationships by Sara Godil, source=Web Response No relevant relationships by Kareem Godil, source=Web Response No relevant relationships by Lalita Shastry, source=Admin input

Impact of Rapid On-Site Cytological Evaluation (ROSE) on the Diagnostic Yield of Transbronchial Needle Aspiration During Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis

Whether the use of rapid on-site cytologic evaluation (ROSE) increases the diagnostic yield of transbronchial needle aspiration (TBNA) remains unclear. This article is a systematic review of studies describing the utility of ROSE in subjects undergoing TBNA. The study included a systematic review of the PubMed, Embase, and Scopus databases for randomized controlled trials investigating the diagnostic yield of conventional transbronchial needle aspiration (c-TBNA) or endobronchial ultrasound (EBUS)-TBNA, with or without ROSE, in subjects with mediastinal lymphadenopathy. Five studies (618 subjects; two EBUS-TBNA, two c-TBNA, and one both) were identified. Overall, the studies were of good quality. The pooled risk difference (95%CI) of the diagnostic yield of EBUS-TBNA and c-TBNA was 0.04 (-0.01 to 0.09) and 0.12 (-0.08 to 0.33), respectively, suggesting no added benefit with ROSE. The use of ROSE during EBUS-TBNA (but not c-TBNA) resulted in significantly fewer needle passes (mean difference [95%CI], -1.1 [-2.2 to -0.005]; P< .001). There was no difference in the procedure time during EBUS-TBNA. The complication rate was significantly lower (OR [95%CI], 0.26 [0.10 to 0.71]; P= .009) when ROSE was used during c-TBNA due to fewer additional procedures required to make a diagnosis. There was evidence of heterogeneity in the studies involving c-TBNA but not EBUS-TBNA. There was no publication bias. The use of ROSE neither improved the diagnostic yield nor reduced the procedure time during TBNA. However, the use of ROSE was associated with fewer number of needle passes during EBUS-TBNA and overall lower requirement for additional bronchoscopy procedures during TBNA to make a final diagnosis. PROSPERO; No.: CRD42017058937; URL: www.crd.york.ac.uk/prospero/.

Flexible needle with integrated optical coherence tomography probe for imaging during transbronchial tissue aspiration.

Transbronchial needle aspiration (TBNA) of small lesions or lymph nodes in the lung may result in nondiagnostic tissue samples. We demonstrate the integration of an optical coherence tomography (OCT) probe into a 19-gauge flexible needle for lung tissue aspiration. This probe allows simultaneous visualization and aspiration of the tissue. By eliminating the need for insertion and withdrawal of a separate imaging probe, this integrated design minimizes the risk of dislodging the needle from the lesion prior to aspiration and may facilitate more accurate placement of the needle. Results from in situ imaging in a sheep lung show clear distinction between solid tissue and two typical constituents of nondiagnostic samples (adipose and lung parenchyma). Clinical translation of this OCT-guided aspiration needle holds promise for improving the diagnostic yield of TBNA.

‘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.

Diagnostic yield of transbronchial needle aspiration for lymphoma

&lt;p&gt;Background. Transbronchial needle aspiration (TBNA) is a minimally invasive bronchoscopic technique that is cost-effective and safe for diagnosing mediastinal and hilar adenopathy in lung cancer, other malignancies, sarcoidosis and infectious processes such as tuberculosis. Few studies have analysed the sensitivity, specificity and predictive values of TBNA for diagnosing lymphoma.&lt;/p&gt;&lt;p&gt;Objective. To evaluate the diagnostic yield of TBNA for diagnosing mediastinal and hilar adenopathy in suspected lymphoma.&lt;/p&gt;&lt;p&gt;Methods. We performed a retrospective analysis of collected data of patients with mediastinal and hilar adenopathy adjacent to the tracheobronchial tree detected by thoracic computed tomography, who underwent TBNA at Tygerberg Hospital between July 2010 and June 2013. We included 25 patients with suspected or proven lymphoma. Histology was used as the gold standard.&lt;/p&gt;&lt;p&gt;Results. Adequate samples for cytological evaluation were obtained for 22 (88%) patients. Cytological diagnosis was possible for 8 (32%). For 17 (68%) who could not be diagnosed by TBNA alone, histology provided final diagnosis. Rapid on-site examination (ROSE) was performed in 23 (92%). In 17/23 (74%) cases, these had similar results to formal cytology. Only 4 (16%) had flow cytometry requested. Twelve (48%) had lymphoma confirmed on histology. TBNA cytology had 100% specificity and positive predictive value for suspicion of lymphoma. Sensitivity was 33% and negative predictive value 62%.&lt;/p&gt;&lt;p&gt;Conclusion. TBNA is an appropriate first-line diagnostic procedure in evaluating mediastinal and hilar lymphadenopathy in suspected lymphoma. Biopsy should be the immediate second-line procedure when ROSE/cytology is suspicious of lymphoma or shows atypical cells. Patients with negative TBNA cytology, but high clinical or radiological suspicion of lymphoma, should be further investigated.&lt;/p&gt;

How to increase the yield of transbronchial needle aspiration (TBNA)

Transbronchial needle aspiration (TBNA) is a relatively sensitive, accurate, and safe technique in the diagnosis and staging of lung cancer. There are many factors influencing the yield of TBNA, such as location and the size of the mediastinal lymphadenopathy (MLN), types of the needle used and the experience of the bronchoscopist. Furthermore, knowledge of anatomy, guidance, availability of rapid on-site evaluation (ROSE) and the number of aspirates, preparation of specimen and interpretations of the cytology and histology of specimens all play important roles. Especially, whether an endobronchial ultrasound (EBUS) is required for TBNA in the diagnosis of mediastinal masses is currently a disputed subject.

Insight into the differences in classification of mediastinal and hilar lymph nodes between Wang's lymph node map and the International Association for the Study of Lung Cancer lymph node map.

Lung cancer is the leading cause of malignant-tumor-related morbidity and mortality worldwide. Transbronchial needle aspiration (TBNA) has for the past 30 years been an effective technique for the diagnosis and staging of lung cancer. Understanding the anatomy of mediastinal and hilar lymph nodes is essential to improve the yield of TBNA. Wang's lymph node map is based on the lymph node map of the American Thoracic Society (ATS), and on the TBNA technique; it was published in 1994, and has promoted the development of both conventional TBNA (cTBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In 2009, the International Association for the Study of Lung Cancer (IASLC) developed a new chest lymph node map to reconcile the differences between the Naruke and The Mountain-Dresler (MD)-ATS lymph node maps. The IASLC lymph node map was incorporated into the seventh edition of the tumor, node, metastasis (TNM) staging system for lung cancer, which directly affected the treatment and prognosis of lung cancer. There are significant differences between Wang's lymph node map and the IASLC lymph node map in TNM staging, and it is imperative to understand these differences and correlate these maps for the prognosis and staging of lung cancer using cTBNA or EBUS-TBNA.

Yield of transbronchial needle aspiration of mediastinal lymph nodes of 36 cases

BackgroundBesides 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 and diagnosing other inflammatory diseases i.e. sarcoidosis tuberculosis. ObjectiveOur study had the principal objective to evaluate the positivity of transbronchial needle aspiration (TBNA). MethodWe retrospectively reviewed 36 patients using bronchoscopy and histopathological reports and corresponding patients chart over 3years from January, 2009 to December, 2012 at the department of chest disease at Mansoura University. ResultsA total of 38 underwent FFB procedures. 2 (5%) patients were excluded due to incomplete follow up data.The yield of TBNA was positive in 22 patients (61%), of them 9 patients (25%) were positive for malignancy and 13 patients (36%) were diagnosed as inflammatory disease i.e. tuberculosis or sarcoidosis.Only 3 patients (8%) had documented bleeding after TBNA and, bleeding stopped spontaneously. No mortality was reported due to this procedure. ConclusionOur study indicated that this method is safe, easy to perform, with a minimum of complications and useful for the diagnosis and staging of pulmonary neoplasms and mediastinal lymph node enlargement.

Efficacy and Safety of Conventional Transbronchial Needle Aspiration in Sarcoidosis: A Systematic Review and Meta-analysis

Flexible bronchoscopic procedures are currently the most often employed technique for demonstrating granulomatous inflammation in sarcoidosis. Conventional transbronchial needle aspiration (TBNA) has been used for over 3 decades; however, it remains an underutilized technique, primarily due to the wide variations in the reported success rates and unconfirmed safety concerns. Herein we perform a systematic review and meta-analysis of studies to estimate the diagnostic yield and safety of TBNA in sarcoidosis. We searched the PubMed and EmBase databases for studies (1980 to January 2012) reporting the efficacy of TBNA in sarcoidosis. The quality of studies was assessed using the QualSyst tool. The efficacy of TBNA in individual studies was calculated as proportions and 95% CIs, and the results were pooled using a random effects model. Heterogeneity and publication bias were assessed for the individual outcomes. Our search yielded 21 studies (915 patients). The diagnostic yield of TBNA ranged from 6-90%, with the pooled efficacy being 62% (95% CI 52-71%) by the random effects model. TBNA was not associated with any major complication. The diagnostic yield increased to 83% if transbronchial lung biopsy (TBLB) was additionally performed, albeit with increased complications. There was evidence of heterogeneity and publication bias, which significantly decreased on sensitivity analysis after exclusion of retrospective studies. TBNA is an efficacious and safe procedure in the diagnosis of sarcoidosis. The performance of TBLB adds to the efficacy of TBNA. Hence, a combination of TBNA and TBLB should be routinely employed in diagnosis of sarcoidosis in those with enlarged mediastinal lymph nodes.

Sarcoidal Granulomas in Cytological Specimens from Intrathoracic Adenopathy: Morphologic Characteristics and Radiographic Correlations

Background: Clinical experience and literature data suggest that the ability of pathologists to identify granulomas in cytological specimens from intrathoracic lymphadenopathy varies considerably and may negatively influence the yield of transbronchial needle aspiration (TBNA), both conventional and ultrasound-guided (EBUS-TBNA). Objectives: To describe the cytomorphology of sarcoidal granulomas on TBNA cytology specimens and to analyze the presence of associations between the cytological characteristics of granulomas and the radiographic stage of sarcoidosis. Methods: TBNA cytological specimens from 123 sarcoidosis patients and 14 tuberculosis patients (control population) were reviewed independently by two pathologists blinded to the clinical-radiological details. Results: Sarcoidal granulomas were small [median (IQR) largest diameter: 0.478 (0.318-0.701) mm] and well-formed, round or elliptical in shape, and almost invariably had a regular contour. Background elements lacked necrotic debris or exudate. The density [median (IQR) number of granulomas per slide: 6.85 (3.66-11) vs. 5.25 (2.5-8), p = 0.073] and size [median (IQR) largest diameter: 0.51 (0.319-0.733) vs. 0.398 (0.318-0.522), p = 0.071] tended to be larger in stage I than in stage II sarcoidosis. A necrotic background was common in the tuberculosis cohort studied (79 vs. 0%, p < 0.0001). Conclusions: Granulomas can be reliably identified on TBNA cytological material once their characteristic cytomorphology is delineated. A higher density of granulomas in lymphadenopathy of stage I sarcoidosis patients could partly explain the higher success rate constantly obtained by TBNA and EBUS-TBNA in this stage of the disease. A necrotic background suggests a tubercular etiology of the granulomas over a sarcoidal one, in the appropriate clinical setting.

An electromagnetic navigation system for transbronchial interventions with a novel approach to respiratory motion compensation

Bronchoscopic interventions, such as transbronchial needle aspiration (TBNA), are commonly performed procedures to diagnose and stage lung cancer. However, due to the complex structure of the lung, one of the main challenges is to find the exact position to perform a biopsy and to actually hit the biopsy target (e.g., a lesion). Today, most interventions are accompanied by fluoroscopy to verify the position of the biopsy instrument, which means additional radiation exposure for the patient and the medical staff. Furthermore, the diagnostic yield of TBNA is particularly low for peripheral lesions. To overcome these problems the authors developed an image-guided, electromagnetic navigation system for transbronchial interventions. The system provides real time positioning information for the bronchoscope and a transbronchial biopsy instrument with only one preoperatively acquired computed tomography image. A twofold respiratory motion compensation method based on a particle filtering approach allows for guidance through the entire respiratory cycle. In order to evaluate our system, 18 transbronchial interventions were performed in seven ventilated swine lungs using a thorax phantom. All tracked bronchoscope positions were corrected to the inside of the tracheobronchial tree and 80.2% matched the correct bronchus. During regular respiratory motion, the mean overall targeting error for bronchoscope tracking and TBNA needle tracking was with compensation on 10.4 ± 1.7 and 10.8 ± 3.0 mm, compared to 14.4 ± 1.9 and 13.3 ± 2.7 mm with compensation off. The mean fiducial registration error (FRE) was 4.2 ± 1.1 mm. The navigation system with the proposed respiratory motion compensation method allows for real time guidance during bronchoscopic interventions, and thus could increase the diagnostic yield of transbronchial biopsy.

Endobronchial-Ultrasound Guided Miniforceps Biopsy of Mediastinal and Hilar Lesions

Linear array endobronchial ultrasound (EBUS) has greatly improved the diagnostic yield of transbronchial needle aspiration (TBNA) for the diagnosis of non-small cell lung carcinoma though its yield in granulomatous disease and lymphoproliferative disorders is less robust. The EBUS-miniforceps biopsy (MFB) uses miniforceps and the convex probe EBUS bronchoscope to obtain forceps biopsies of centrally located lesions under continuous ultrasound guidance. In this prospective study we evaluate the efficacy of this technique for diagnosing mediastinal and hilar abnormalities in patients with a low suspicion for non-small cell lung carcinoma. Patients presenting with mediastinal or hilar lymphadenopathy and a low likelihood of non-small cell lung carcinoma underwent EBUS-TBNA and EBUS-MFB of mediastinal and hilar abnormalities. The diagnostic yield EBUS-TBNA and EBUS-MFB was compared as was the combined yield of both techniques versus either technique alone. Between June 2008 and July 2010, 50 patients underwent EBUS-TBNA and EBUS-MFB of 74 lymph node stations. The overall diagnostic yield of EBUS-TBNA and EBUS-MFB was 81% (60 of 74) and 91% (67 of 74), respectively (p=0.09). When the 2 techniques were combined, the overall diagnostic yield was 97% (72 of 74) (p<0.001), which was significant when compared with EBUS-TBNA alone. No complications were observed as a result of EBUS-MFB, and EBUS-MFB did not appear to significantly prolong the procedure. The EBUS-miniforceps biopsy is an effective, safe, and efficient method of obtaining histopathologic specimens from mediastinal and hilar abnormalities in patients with a low likelihood of non-small cell lung carcinoma, particularly when the technique is combined with EBUS-TBNA.

Rapid On-site Evaluation of Transbronchial Aspirates in the Diagnosis of Hilar and Mediastinal Adenopathy: A Randomized Trial

Rapid on-site evaluation (ROSE) of transbronchial needle aspirates has long been used during flexible bronchoscopy, but its usefulness in the diagnosis of hilar and mediastinal adenopathy is controversial. The aim of the present study was to evaluate the extent to which ROSE can be valuable in patients undergoing transbronchial needle aspiration (TBNA) for the diagnosis of hilar and mediastinal adenopathy. A total of 168 consecutive patients with enlarged lymph nodes were randomized to undergo TBNA with or without ROSE. The primary outcome measure of the study was the diagnostic yield of TBNA on a per-patient basis. Secondary outcome measures included the percentage of adequate specimens on a per-lymph node basis, the number of biopsy sites on a per-patient basis, and the complication rate of bronchoscopy on a per-patient basis. We found no significant difference between the TBNA group and the ROSE group in terms of diagnostic yield (75.3% vs 78.3%, respectively; P = .64), and percentage of adequate specimens (86.5% vs 78.4%, respectively; P = .11). The median (interquartile range) number of biopsy sites was significantly lower in the ROSE group (1 [1-2] vs 2 [1-2], respectively; P = .0005). The complication rate of bronchoscopy was significantly lower in patients undergoing on-site review (6% vs 20%; P = .01), whereas the complication rate of TBNA was similar among the study groups. ROSE of transbronchial aspirates from hilar and mediastinal nodes enables avoidance of additional biopsy without loss in diagnostic yield and reduces the complication rate of bronchoscopy. ClinicalTrials.gov; No.: NCT00915330; URL: www.clinicaltrials.gov

FDG Uptake and the Diagnostic Yield of Transbronchial Needle Aspiration

The objective of our study was to investigate whether fluorodeoxyglucose (FDG) positron emission tomography scanning uptake impacts the yield of transbronchial needle aspiration (TBNA). We carried out a retrospective analysis of data from 140 consecutive patients (178 lymph nodes) undergoing positron emission tomography-computed tomography scanning and subsequent TBNA with rapid onsite cytologic evaluation of the specimen. Patient and lymph node characteristics, including nodal station, size, FDG uptake, number of passes with the needle, sample adequacy, and the final diagnosis were recorded. The diagnostic yield of TBNA was 75%. Themean short axis lymph node diameter was 18.7±9 mm and mean maximum standardized uptake value (SUVmax) was 7.7±4. The diagnostic yield depended on the lymph node size [odds ratio (OR)=1.07 (1.00-1.14); P=0.04], clinical suspicion of malignancy [OR=5.13 (1.95-13.52); P=0.001], malignant diagnosis [OR=4.91 (1.71-14.09); P=0.003], and FDG uptake [for SUVmax cutoff of 3.0: OR=33.8 (9.2-124); P<0.001]. Only clinical suspicion of cancer [OR=6.2 (2.2-17.2); P=0.001] and FDG uptake [for SUVmax cutoff of 3.0: OR=33.8 (9.2-123.8); P<0.001] remained significant on multivariate analysis. Receiver operating characteristic curves combining 3 key variables (lymph node size, clinical suspicion of malignancy, and SUVmax) showed an area of 0.83 under the curve for a 2.5 SUVmax cutoff and 0.84 for a 3.0 cutoff. FDG uptake is the single most important variable impacting the TBNA yield. TBNA of lymph nodes with an SUVmax less than 3.0 is rarely diagnostic.

Non-Real-time CT-Guided TBNA/TBB: A Novel Method of Increasing Diagnostic Yield in TBNA and TBB

PURPOSE: To enhance the yield of transbronchial needle aspiration (TBNA), advanced interventions like Endobronchial Ultrasound (EBUS) and CT fluoroscopic TBNA are utilized. However, these are not easily available in all countries and centers outside the USA. We conducted this analysis to evaluate the yield of NON-REAL TIME CT-guided TBNA transbronchial biopsy (TBB) sampling for mediastinal lymph nodes (LN) and peripheral lesions.

A strategy to improve the yield of transbronchial needle aspiration

Transbronchial needle aspiration (TBNA) is a bronchoscopic technique that provides access to masses within the mediastinum. It is operator dependent, and factors such as needle type, lymph node site, and endobronchial ultrasosonography (EBUS) have been implicated as having an impact on its accuracy. This study aimed to develop a strategy for TBNA and specimen preparation techniques as the first step toward improving TBNA yield, and to determine whether EBUS can augment its application. Intervention included standardizing the use of the histology needle and the direct smear method. As competency improved, radial probe (RP) and linear EBUS were incorporated into TBNA. The study assessed 35 conventional TBNA procedures before and 45 of these procedures after intervention as well as 45 RP-EBUS and 50 linear EBUS-guided TBNA procedures. Frequently sampled lymph node stations were 7, 4R, and 4L in the American Thoracic Society classification. The preintervention conventional TBNA yield was 43%, which improved to 82% after intervention. Although EBUS did not have an impact on TBNA yield (p = 0.44) compared with the intervention (p = 0.001), EBUS was useful for lymph nodes smaller than 2 cm (p < 0.0001). Linear EBUS did not confer higher diagnostic accuracy than RP-EBUS (p = 0.47). Proper TBNA and specimen preparation techniques are the first steps toward improving TBNA yield, and EBUS can be used to guide TBNA of small lymph nodes.

Endobronchial Ultrasound-guided Transbronchial Miniforceps Biopsy of Mediastinal and Hilar Lymph Node Stations

Linear array endobronchial ultrasound has significantly improved the diagnostic yield of transbronchial needle aspiration for the diagnosis of centrally located lesions within the thorax. Although transbronchial needle aspiration has become an accepted technique for diagnosing solid tumors within the chest, its yield for hematologic malignancies such as lymphoma and other benign conditions in which direct examination of tissue architecture are preferred is lower. Currently, surgical biopsies by mediastinoscopy or video-assisted thoracic surgery are often required to obtain adequate tissue specimens to make these diagnoses. In this retrospective study, we review our experience with patients who underwent endobronchial ultrasound-guided miniforceps biopsy of abnormalities at mediastinal and hilar lymph node stations.

Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration Increases the Diagnostic Yield of Peripheral Pulmonary Lesions: A Randomized Trial

The diagnostic yield of endobronchial ultrasonography (EBUS)-guided transbronchial needle aspiration (TBNA) for peripheral pulmonary lesions (PPLs) has not been evaluated. The diagnostic impact of TBNA when the EBUS probe is adjacent to lesions remains to be determined. A prospective, randomized trial. Two hundred two patients with PPLs and positive EBUS findings were enrolled. They were randomly classified into two groups. In the EBUS conventional diagnostic procedures (CDPs) group (103 patients), both transbronchial biopsy (TBB) and bronchial washing (BW) were performed. In the EBUS-TBNA plus CDPs group (99 patients), TBNA, TBB, and BW were performed. The diagnostic yield in each group was compared. A total of 182 patients (94 in the EBUS CDPs group and 88 in the EBUS-TBNA plus CDPs group) were analyzed. The yield in the EBUS-TBNA plus CDPs group (78.4%) was significantly higher than the EBUS CDPs group (60.6%, p = 0.015). Cases in which the EBUS probe was located within the lesions had a significantly higher diagnostic yield (78.3%) than when the EBUS probe was adjacent to them (47.2%, p < 0.001). Concerning the three different techniques, TBNA showed the highest diagnostic yield (62.5%) in comparison to TBB (48.9%) and to BW (19.8%). The diagnostic yield of TBNA remained unchanged even when the EBUS probe was adjacent to the lesions (p = 0.89). No additional adverse effects were observed in the EBUS-TBNA plus CDPs group. Applying TBNA to EBUS-guided CDPs further increased the diagnostic yield of PPLs without additional risk. The diagnostic advantage of TBNA became more obvious if the EBUS probe was adjacent to the lesions. Clinicaltrials.gov Identifier: NCT00626587.

Real-time endobronchial ultrasound-guided transbronchial needle aspiration: preliminary study on mediastinal and hilar lymph nodes of lung cancer

To observe the value and safety of real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) on mediastinal and hilar lymph nodes of lung cancer. During July 2008 to December 2008, 25 patients (18 males, 7 females), (68 +/- 9) years old, with proven or radiologically suspected lung cancer were enrolled. EBUS-TBNA was performed to obtain samples from 28 lymph nodes of these patients. And 28 lymph nodes of 26 same eligible patients [(18 males, 8 females, (66 +/- 8) years old] were sampled with conventional TBNA by the same operator during January 2008 to June 2008. A positive result was either a specific diagnosis (eg, malignant cells) or a lymphocyte-positive specimen. The results and complications of EBUS-TBNA versus conventional TBNA were compared. The yield of EBUS-TBNA, 92.9%, was significantly higher than 60.7% (17/28 nodes) of conventional TBNA (chi2 = 8.114, P = 0.004). No pneumothorax, airway rupture, hemorrhage (> 5 ml) and other complications were observed for the patients operated with EBUS-TBNA and conventional TBNA. Real-time EBUS guidance significantly increases the yield of TBNA on mediastinal and hilar lymph nodes of lung cancer, and EBUS-TBNA is safe. Further application studies are needed.