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.

Background: In patients with severe chronic obstructive pulmonary disease (COPD), pursed-lips breathing (PLB) improves the pulmonary gas exchange and hyperinflation measured by electro-optic coupling. The response to PLB in inspiratory lung function tests is not known. Objectives: The purpose of this study was to measure the effect of PLB on inspiratory parameters. Methods: Thirty-five subjects with stable COPD and a forced expiratory volume in first second (FEV₁) <50% of the predicted value were tested for the following primary parameters before and immediately after PLB, and 5 min later: forced inspiratory vital capacity, inspiratory capacity (IC), forced inspiratory volume in first second, maximal inspiratory flow at 50% of vital capacity, and peak inspiratory flow. Patients were also tested for the following secondary parameters: vital capacity, FEV₁, breathing frequency, end-tidal CO₂ tension, and oxygen saturation. Results: Of all the primary parameters only IC (p = 0.006) improved significantly; with regard to the secondary parameters, the mean oxygen saturation was improved by 1% (p = 0.005) and the mean end-tidal CO₂ tension and breathing frequency decreased significantly (p < 0.0001 for both) to 3.2 mm Hg and 3.1 breaths/min, respectively. After 5 min the effects diminished. Conclusion: Improved IC after PLB indicates less hyperinflation in patients with severe COPD; there was no effect on parameters of flow.

Background: Despite its proven efficacy, transbronchial needle aspiration (TBNA) remains an underutilized technique for sampling enlarged mediastinal lymph nodes in the staging of lung cancer. Previous investigators have reported on TBNA experience, but without mentioning individual learning curves related to lymph node size in pulmonologists experienced in bronchoscopy. Objectives: The aim of this study was to evaluate the TBNA learning curve in a group of pulmonologists already experienced in bronchoscopy, and to relate their yields to lymph node size and location. Methods: Data on TBNA yield and related lymph node size were collected retrospectively for five individual pulmonologists. Results: The diagnostic yield of five pulmonologists who started to perform TBNA was evaluated over the first 32 months. TBNA was performed on 138 lymph nodes in 119 patients. The overall diagnostic yield was 77% (range 67–91%). The average diagnostic yield increased from 77% at the start of the learning curve to 82% after 32 months of experience. It was related to lymph node size, but not to lymph node location. The average lymph node size was 22 mm. Conclusions: Satisfactory results were obtained immediately after introduction of TBNA in the bronchoscopy workup. There is no significant TBNA learning curve. The diagnostic yield was related to lymph node size but not to lymph node location.

The present study demonstrates that ILPs improved significantly after using either device. Although significant correlations were found between the VAS and FIF(50) and PIF for the nebulizer, in stable COPD patients, the pMDI plus spacer is a better route of administration than a nebulizer.

Symptomatic lung sequesters are usually treated with resection. 1 Most often the aberrant arterial supply is ligated or reimplanted onto the pulmonary artery. Baek and colleagues 2 recently described a patient with anomalous arterial supply of a left basal segment of the lung in which mere ligation of the anomalous artery produced a satisfactory result. 2 We present a similar case in which resection had to be performed despite our initial goal to preserve the entire lung.