Transbronchial Needle Aspiration in the Diagnosis of Intrathoracic Lymphadenopathy

Abstract

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.

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis)

“…However, interpretting cytology specimen needs more expertise. In the study of Cetinkaya et al, diagnostic yield of TBNA in the patients with adequate lymph node tissue was obtained have been reported as 87% including fewer tuberculosis and malignency patients (25). In the present study, the diagnostic yield of TBNA biosy was the lowest among the biopsy techniques.…”

The Role of Transcarinal Needle Aspiration in the Diagnosis and Staging of Lung Cancer: Computed Tomographic Correlates of a Positive Result

“…The use of the 19-gauge histology needle may provide the advantage of a higher positive yield [20], avoiding the risk of false-positive results. Though TBNA using the histology needle has a great value in the diagnosis of malignant as well as benign conditions [21], the TBNA technique using the histology needle is much more difficult [22], so the cytology needle is probably adequate to use for staging. Mediastinoscopy is the most accurate method of ascertaining mediastinal staging of lung cancer, and it has been the standard procedure to date [11, 12, 23].…”

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

“…If needed, a PCR method can also be employed (20). In a study conducted by Cetinkaya et al on intrathoracic lymphadenopathy patients to evaluate the TBNA method, it was concluded that TBNA was a valuable tool in the diagnosis of tuberculosis and sarcoidosis and should be considered before other invasive methods (21).…”