Chest
Volume 115, Issue 5, May 1999, Pages 1237-1241
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Clinical Investigations
LUNG CANCER
Utility of Transbronchial Needle Aspiration in the Diagnosis of Endobronchial Lesions

https://doi.org/10.1378/chest.115.5.1237Get rights and content

Background

The utility of transbronchial needle aspiration (TBNA) in visible endobronchial lesions presenting as either an exophytic mass lesion (EML) or submucosal and peribronchial disease (SPD) is not well established.

Objective

To compare the yield of conventional diagnostic procedures (CDP) (bronchial washing, bronchial brushing, and endobronchial forceps biopsy) with that obtained from a combination of CDP and TBNA (CDP + TBNA).

Design

Prospective study of 55 patients.

Setting

Tertiary-care referral hospital.

Results

Of the 55 patients in whom malignancy was confirmed, CDP + TBNA identified 53 (96%) vs 42 (76%) identified by CDP (p = 0.001). The highest yield from any individual procedure was obtained by TBNA. Of the 23 patients with SPD, 22 (96%) were diagnosed using CDP + TBNA compared with 15 (65%) by CDP (p = 0.016); the yield from TBNA alone (22 of 23) in this group surpassed the combined yield from all other procedures. Although no statistically significant difference in yield was observed for EML, the use of TBNA identified four additional patients compared with CDP.

Conclusion

We conclude that the addition of TBNA to CDP increases diagnostic yield in patients with visible endobronchial lesions.

Section snippets

Materials and Methods

Patients found to have EML or SPD during routine fiberoptic bronchoscopy were entered in the study. Patients with preexisting known malignancy were excluded. Submucosal disease was defined as erythema, vascular flares, enhanced rugal pattern, thickening or loss of mucosal markings, and bronchial narrowing. Peribronchial disease was defined as luminal narrowing secondary to extrinsic compression.

All patients had bronchial washings (BW), brush biopsy (BB), EBB, and TBNA. The procedural sequence

Results

During a 15-month period, 58 patients were enrolled in the study (Fig 1). Three patients were excluded–two because of benign lesions (one with granulation tissue and one with benign sinus histiocytosis on mediastinoscopy), and one patient refused further investigations.

Of the 55 eligible patients, 32 (58%) had EML and 23 (42%) had SPD. Malignancy was confirmed by bronchoscopy in 53 patients–1 patient had metastatic malignant melanoma and 52 patients had primary lung cancer. The two patients

Discussion

Only a small number of investigators have addressed the issue of TBNA in EML or SPD.67891011 The yield from EBB for EML has been reported to be between 67% and 100% in different series.34578910 The yield could be decreased if there is surface necrosis of the tumor, sampling error, or inadequate tissue, or in the presence of crush artifacts. Similarly, the yield from BB and BW has been demonstrated to be between 55% and 93%,37891012 and 0% and 63%,791012respectively. Furthermore, reported yield

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Presented in abstract form at the annual session of the American Thoracic Society, Chicago, IL, April 28, 1998.

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