Transbronchial Needle Aspiration in Clinical Practice

Harrow, Edward M.; Oldenburg, Frederick A.; Lingenfelter, Mark S.; Smith, AL

doi:10.1378/chest.96.6.1268

Cited by 103 publications

(46 citation statements)

References 14 publications

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“…The major concern with false positive results is that some patients would be denied a curative resection. A few false positives were described in most of the studies concerning punctures through flexible bronchoscopes [5][6][7]. Using that technique, SHURE and FEDULLO [12] had no false positives, but obtained a sensitivity of only 15%.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, in the preoperative assessment, we aim to minimize the risk of false positive results due to contamination of the specimen by endobronchial malignant cells. This risk -although low with the newer flexible devices -is still present in techniques using small diameter flexible needles [5][6][7]. Secondly, although our standard bronchoscopy is carried out by means of fibreoptics, expertise in rigid bronchoscopy has been maintained in our endoscopy unit, e.g.…”

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confidence: 99%

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Transcarinal needle aspiration biopsy in the staging of lung cancer

Vansteenkiste¹,

Lacquet²,

Demedts³

et al. 1994

Eur Respir J

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T Tr ra an ns sc ca ar ri in na al l n ne ee ed dl le e a as sp pi ir ra at ti io on n b bi io op ps sy y i in n t th he e s st ta ag gi in ng g o of f l lu un ng g c ca an nc ce er r Eighty lung cancer patients with subcarinal lymph nodes visible on computed tomography (CT) scan were studied. Specimens were of histological quality (i.e. lymph node tissue) in 59 out of 80 (74%) patients, and showed malignant invasion of this lymph node tissue in 43 cases. Specimens of cytological quality (i.e. lymph node cells) were obtained in 13 out of 80 (16%) patients, and showed malignancy in 7 cases. Therefore, adequate evaluation of the subcarinal lymph nodes was possible in 72 out of 80 (90%) patients. In 50 of these 72, malignant mediastinal spread was proven, and further invasive surgical staging could be avoided. Subgroup analysis showed that this outcome tended to be more likely in patients with abnormal endoscopic appearance of the main carina, with locally extensive tumours, and with nonsquamous histology.These results indicate that transbronchial needle aspiration biopsy of subcarinal lymph nodes can be a valuable alternative to more invasive surgical staging in patients selected by CT scan.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Transcarinal needle aspiration biopsy in the staging of lung cancer

Vansteenkiste¹,

Lacquet²,

Demedts³

et al. 1994

Eur Respir J

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“…The complication rate is extremely low (0.5%-2.3%), with several studies reporting no com plications [75,76,88,89] . Other modalities using FNA, such as transbronchial CT or thoracoscopic procedures, cannot be used for the entire mediastinum [14,15,[92][93][94][95][96][97][98][99][100][101] . EUS has the ability to image the aortopulmonary window, the subcarinal nodes, inferior mediastinum, and the entire posterior part of the mediastinum.…”

Section: Discussionmentioning

confidence: 99%

Staging accuracy of esophageal cancer by endoscopic ultrasound: A meta-analysis and systematic review

Puli¹,

Jb²,

Ml³

et al. 2008

WJG

323

191

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AIM:To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS:Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. RESULTS:Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ 2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION:EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.

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“…This could be a reason for lower sensitivity of TBNA in our study in comparison to some previous studies. Largercaliber histology needles (18-gauge or 19-gauge) for TBNA have been reported to increase the yield over that of 21-gauge or 22-gauge needles in bronchogenic carcinoma [19,20,21] and also have been shown to overcome the rare occurrence of false-positive cytologic results [20,22,23,9].…”

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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Transbronchial Needle Aspiration in Clinical Practice

Cited by 103 publications

References 14 publications

Transcarinal needle aspiration biopsy in the staging of lung cancer

Transcarinal needle aspiration biopsy in the staging of lung cancer

Staging accuracy of esophageal cancer by endoscopic ultrasound: A meta-analysis and systematic review

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

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