Exclusive Diagnostic Contribution of the Histology Specimens Obtained by 19-Gauge Transbronchial Aspiration Needle in Suspected Malignant Intrathoracic Lymphadenopathy

Stratakos, Grigorios; Porfyridis, Ilias; Papas, Vassilis; Kandaraki, C; Zisis, Charalampos; Mariatou, Vasso; Liapikou, Adamantia; Roussos, Charis; Zakynthinos, Spyros

doi:10.1378/chest.07-1920

Cited by 21 publications

(18 citation statements)

References 19 publications

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“…As for the influence of needle size on the diagnostic yield of conventional TBNA, the literature suggests that better success rates are obtained with the use of 19-gauge needles, as compared with 22-gauge needles, but these results come from a limited number of observational trials subjected to significant bias, and most studies lack randomization [14,15,16,17]. …”

Section: Results Of Pico Questionmentioning

confidence: 99%

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

et al. 2014

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Rationale: Conventional transbronchial needle aspiration (TBNA) and endobronchial ultrasound (EBUS)-TBNA are widely accepted tools for the diagnosis and staging of lung cancer and the initial procedure of choice for staging. Obtaining adequate specimens is key to provide a specific histologic and molecular diagnosis of lung cancer. Objectives: To develop practice guidelines on the acquisition and preparation of conventional TBNA and EBUS-TBNA specimens for the diagnosis and molecular testing of (suspected) lung cancer. We hope to improve the global unification of procedure standards, maximize the yield and identify areas for research. Methods: Systematic electronic database searches were conducted to identify relevant studies for inclusion in the guideline [PubMed and the Cochrane Library (including the Cochrane Database of Systematic Reviews)]. Main Results: The number of needle aspirations with both conventional TBNA and EBUS-TBNA was found to impact the diagnostic yield, with at least 3 passes needed for optimal performance. Neither needle gauge nor the use of miniforceps, the use of suction or the type of sedation/anesthesia has been found to improve the diagnostic yield for lung cancer. The use of rapid on-site cytology examination does not increase the diagnostic yield. Molecular analysis (i.e. EGFR, KRAS and ALK) can be routinely performed on the majority of cytological samples obtained by EBUS-TBNA and conventional TBNA. There does not appear to be a superior method for specimen preparation (i.e. slide staining, cell blocks or core tissue). It is likely that optimal specimen preparation may vary between institutions depending on the expertise of pathology colleagues.

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Section: Results Of Pico Questionmentioning

confidence: 99%

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

et al. 2014

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“…Of the studies investigating type of specimen with histological needle, all six reported a higher diagnostic performance for combined (both histological and cytological) and histological specimens than that for cytological specimens [33,47,48,51,52,53]. …”

Section: Resultsmentioning

confidence: 99%

“…Out of twelve studies, six reported small cell type as the best predictor [21,24,25,40,45,49], two identified non-small cell [18,23] and four did not detect any statistically significant difference in TBNA accuracy according to cell subtype [7,26,34,51]. …”

Section: Resultsmentioning

confidence: 99%

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

et al. 2013

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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.

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“…In other studies, the definition of FN was based on the influence that the TBNA result had in the final decision about patient management [17].…”

Section: Discussionmentioning

confidence: 99%

Role of Transbronchial Needle Aspiration in Patients with Thoracic Lymphadenopathy on CT Scan

Mukul¹

2013

AJIM

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Abstract:Context: Transbronchial needle aspiration (TBNA) is a method in which an aspirating needle is used to obtain diagnostic samples from a peribronchial or submucosal lesion through a rigid [1] or flexible bronchoscope [2]. Though it is a very useful bronchoscopic technique it still remains underutilized [3]. Aims: This study was done to evaluate the sensitivity, complication rates and factors affecting the outcome of TBNA. Settings and Design: Prospective trial of fifty two patients with mediastinal lymphadenopathy on CT scan attending Respiratory Diseases Clinic of Jawaharlal Nehru Medical College Hospital. Methods and Material: We analyzed the outcome of TBNA in fifty two patients who underwent TBNA between 2010 and 2012. Sensitivity of TBNA was calculated and factors affecting the TBNA results were analyzed. Statistical analysis used:Chi square test was used for analyzing the factors affecting TBNA results. SPSS Statistics 17.0 was used for analysis. Results: The overall sensitivity of TBNA was found to be 59.6% and it was the only diagnostic technique in 47.6% of the patients. Factors associated with diagnostic acquisition of samples were lymph node size more than 1.5 cm and the presence of indirect signs on bronchoscopy. Conclusions: The sensitivity of TBNA is high in malignant mediastinal lymphadenopathy. Complications occurred in four patients who had self limited bleeding at the site of puncture which healed spontaneously. Important factors predicting the outcome of TBNA are lymph node size and the presence of indirect signs on bronchoscopy. We would recommend this procedure for detection of metastatic lymph nodes in patients with lung cancer and also for mediastinal tubercular lymphadenopathy where diagnosis could not be achieved by less invasive methods.

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Exclusive Diagnostic Contribution of the Histology Specimens Obtained by 19-Gauge Transbronchial Aspiration Needle in Suspected Malignant Intrathoracic Lymphadenopathy

Cited by 21 publications

References 19 publications

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

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

Role of Transbronchial Needle Aspiration in Patients with Thoracic Lymphadenopathy on CT Scan

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