Transbronchial Needle Aspiration: A Systematic Review on Predictors of a Successful Aspirate

Abstract

Background: Transbronchial needle aspiration (TBNA) is a safe and useful sampling technique for the diagnosis of mediastinal adenopathies/masses, but its accuracy seems to be influenced by selected clinical and procedural aspects. Objectives: We performed a systematic review to identify the main predictors of a successful transbronchial aspirate according to different clinical settings. Methods: We searched Medline and Embase for all studies evaluating predictors of TBNA diagnostic yield, published up to February 2012. Two authors reviewed all titles/abstracts and retrieved the full text of articles that are potentially relevant to identify studies according to predefined selection criteria. The methodological quality of studies was assessed through the revised Quality Assessment of Diagnostic Accuracy Studies tool. Evidence synthesis was graded according to overall number of studies, patients involved and methodological features. Results: Fifty-three studies, involving more than 8,000 patients and evaluating 23 potential predictive factors, were included. Major predictors in an unselected population, as well as in patients with suspected/known lung cancer, included lymph node size (short axis length ≥2 cm), presence of abnormal endoscopic findings, subcarinal and right paratracheal location, and the use of histological needle by an experienced bronchoscopist. Stage I and sampling of more than one lymph node stations were the only predictors of a successful TBNA result in patients with suspected sarcoidosis. Conclusions: The diagnostic yield of TBNA depends on selected clinical and procedural features. Knowledge of factors that predict a positive TBNA result may help optimize the diagnostic success of the procedure in different clinical settings.

Diagnostic yield of conventional transbronchial needle aspiration biopsy (C-TBNA) without an on-site cytopathologist: Experience of 363 procedures in 219 patients

“…Some of the studies include unselected patient populations whereas others include patients with specific etiologies like malignancy or sarcoidosis. Systematic review of Bonifazi et al aiming to identify predictors successful TBNA aspirations and to definet hose predictors for different patient populations found LN size (≥ 2 cm for several studies), type of disease, operator experience, endoscopic findings, needle size, number of needle passes (> 3), and LN station (subcarinal and right paratracheal) as factors with strong predictive roles for unselected population (7). In another study investigating the DY of C-TBNA by size, the DY was 0% when the LN diameter was < 2 cm, 63.6% when ≥ 2 cm (13).…”

“…There are randomized trials with results suggesting better diagnostic results with EBUS-TBNA in both lung cancer and sarcoidosis patients (4)(5)(6). Despite better diagnostic results of TBNA with additional imaging, requirement for advanced devices, special equipment and experienced staff for the specific procedure makes wide range application of those techniques uneasy (7). Thus, C-TBNA may still be important for LN sampling in terms of feasibility and practicality.…”

Endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective analysis of 228 patients

“…[10] Although this method can be used to take samples from the hilar and mediastinal lymph nodes, it is more effective in the subcarinal and right paratracheal stations. [11][12][13][14] Moreover, identifying the small lymph nodes (target visualization) and performing biopsies on these lymph nodes with the conventional EBUS-TBNA procedure is difficult. Additionally, Cetinkaya et al [15] found that in conventional EBUS-TBNA, the sensitivity and diagnostic rates were high in cases with negative histopathological results.…”

A cytopathological approach to diagnosing intrathoracic lymphadenopathy using aspirates obtained by the transbronchial needle aspiration method

“…EBUS-TBNA, which is an effective method of extending the bronchoscopist's field of view beyond the bronchial lumen, is still not widely used because expensive equipment is required (2,3). If used by experienced physicians and with sufficient sampling, TBNA, which is an effective, safe and cheap bronchoscopy technique, may reduce the need for invasive procedures in the diagnosis of mediastinal or hilar lymphadenopathy, and the staging of lung cancer (4)(5)(6).…”