Transbronchial Fine-Needle Aspiration: Reliability and Limitations

Abstract

Transbronchial needle aspiration is a new method of sampling pulmonary, paratracheal, and mediastinal masses. A total of 116 aspirations of the lung performed during a two-and-a-half-year period were reviewed. The results were compared with those of bronchial wash, bronchial brush, sputum, transbronchial forceps biopsy, and histologic material subsequently obtained during surgery or at autopsy. Clinical information was also reviewed. Transbronchial needle aspiration was performed on 104 patients, yielding 116 specimens. With the use of a combination of aspiration, wash, brush, sputum, and forceps biopsy, malignancy was detected in 48 patients. Open biopsy, mediastinoscopy, and transcutaneous needle aspiration increased the number of malignant neoplasms detected to 72. The tumors were detected in 67% of these 72 cases by a combination of all bronchoscopic methods. Transbronchial aspiration correctly identified 36% of malignant cases compared with 35% identified by wash, 39% by brush, 25% by sputum, and 59% by forceps biopsy. The overall accuracy of the techniques was 56% for aspiration, 48% for wash, 56% for brush, 35% for sputum, and 71% for forceps biopsy. Malignant cases were associated with cellular transbronchial aspirates, good preservation of cell detail, and a high degree of cytologic/histologic correlation regarding cell type. Transbronchial fine-needle aspiration has the potential for improving the diagnostic ability of bronchoscopy. However, the high incidence of false negative diagnoses is the main limitation for the technique, and the responsible factors are discussed.

Paired ductal lavage and fine-needle aspiration specimens from patients with breast carcinoma

“…urinary tract and distal respiratory airways). In general, in the presence of a tumor mass, FNA is more sensitive than lavage/wash in detecting malignancy, 8 and the results of our study indicate that this is also true with regard to the breast. Because of intrinsic differences in the two techniques, DL and FNA of the breast apply to different clinical scenarios and either one or the other should be chosen based on the clinical setting.…”

Cytology-based treatment decision in primary lung cancer: Is it accurate enough?

“…According to previous findings, false negative results on cytology ranged from 5% to 65% [5][6][7]9,10,[14][15][16][17]19]. This wide variability in cytological yield among studies can be related to several factors, such as size of the study population, the cytological procedure being employed, and quality of specimens, location and size of the lung tumour, endoscopic findings, as well as the investigational procedure regarded as the reference standard.…”

“…Cytological procedures are often employed, as they are less invasive and easier to perform, but their accuracy with regard to lung cancer cell type has been previously questioned [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Payne et al have reported an overall diagnostic accuracy achieved by sputum cytology, bronchial aspirates, and bronchial biopsies of 89%, 86% and 92%, respectively, when compared to histology of resected tumour or necropsy specimen.…”

“…Similar studies have shown diagnostic accuracy in the range of 56-87% for bronchial brushings, 48-84% for bronchial aspirates, and 35-79% for sputum specimens. Again, diagnostic accuracy on cytology was highest for SqCC and SCLC, lower for ADC, and poor for NSCLC-NOS [6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Transbronchial needle aspiration under direct endobronchial ultrasound guidance of PET-positive isolated mediastinal adenopathy in patients with previous malignancy

“…To date, mediastinoscopy and thoracoscopy have been considered as the reference standards for sampling mediastinal lymph nodes, but such methods are invasive, expensive, and require general anesthesia and hospital admission [1]. Actually, there is increasing evidence that transbronchial needle aspiration (TBNA) of the mediastinal lymph nodes under direct realtime endobronchial ultrasound (EBUS) guidance is a safe and useful means of obtaining biopsy specimens from these nodes in lung cancer patients [2][3][4][5]. In addition, cases of mediastinal lymph node metastases from extrathoracic malignancy diagnosed by EBUS TBNA have been reported [6].…”