The Utility of Transbronchial Needle Aspiration in the Staging of Bronchogenic Carcinoma

Abstract

We conducted a prospective multi-institutional clinical study involving community hospitals and academic medical centers to more carefully define the value of computerized tomography (CT) of the chest with transbronchial needle aspiration (TBNA) in the staging of bronchogenic carcinoma (CA), and to assess the predictors of a positive aspirate. Of 360 individuals determined to have bronchogenic carcinoma, 50 of 81 (62%) with small cell carcinoma (SCC) and 135 of 279 (48%) with non-small cell carcinoma (NSCC) had positive aspirates (p = 0.034). TBNA precluded additional thoracic surgery in a total of 104 of 360 (29%) patients and was exclusively diagnostic of carcinoma in 65 of 360 (18%) cases. Right-sided tumors were more likely to have a positive mediastinal TBNA (p = 0.002 to 0. 01) as were histologic (67 of 118 [57%]) rather than cytology aspirates (228 of 532 [41%]) (p < 0.001). Sensitivity was > 57% in lymph nodes (LN) >/= 10 mm, and among LN of equivalent size, right paratracheal and subcarinal sites were most likely to establish malignancy. Preoperative CT is a valuable adjunct in the staging of CA by TBNA. Increasing LN size, right-sided tumors, right paratracheal and subcarinal locations, use of a histology needle, and the presence of SCC are the best predictors of a positive aspirate.

Staging the Mediastinum: What is Current Best Practice?

“…This trend was also described by Harrow et al [20]. The paper describes a linear relationship between diagnostic yield from TBNA and lymph node size: up to 2.5 cm, the larger the lymph node the higher the diagnostic yield [20]. TBNA has an excellent safety profile with no case reports of mortality from the procedure.…”

“…A study by Patelli et al demonstrated a higher diagnostic yield for TBNA comparing right paratracheal nodes (sensitivity 84%) and subcarinal nodes (sensitivity 79%) with left paratracheal nodes (station 4L; 52%) [19]. This trend was also described by Harrow et al [20]. The paper describes a linear relationship between diagnostic yield from TBNA and lymph node size: up to 2.5 cm, the larger the lymph node the higher the diagnostic yield [20].…”

Preliminary Experience With the Use of Electromagnetic Navigation for the Diagnosis of Peripheral Pulmonary Nodules and Enlarged Mediastinal Lymph Nodes

“…1 The same could be said about fine needle aspiration of enlarged mediastinal lymph nodes, albeit for different reasons. In this case, the frustration lies in the difficulty in reproducing the diagnostic yield of very experienced hospitals, 2 especially those, such as ours, that are fortunate enough to have a histopathologist present during the procedure.…”

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

“…When similar studies in the literature were reviewed, it was found that the sensitivity of TBNA was higher in left-sided compared to right-sided tumors, and in right paratracheal and subcranial lymph node aspirates compared to left paratracheal aspirates (9).…”