Chest
Clinical InvestigationsCT Scan Directed Transbronchial Needle Aspiration Biopsy for Mediastinal Nodes
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Materials and Methods
Forty-nine patients (39 men, 10 women; average age, 61 ±12.3 years) underwent chest CT for localizing the mediastinal adenopathy prior to bronchoscopy. All scans were performed on a scanner (Toshiba Xspeed II Scanner; Tokyo, Japan) with scan time of 3 s, using continuous 1-cm slices with adequate IV contrast enhancement in all patients. Significant mediastinal adenopathy was defined as any node >1 cm in diameter in the short axis. The adenopathy is listed in Table 1. The site for penetration
Results
A total of 49 patients with 69 mediastinum adenopathies were enrolled in this study. The most commonly involved LNs are the anterior carina group and the right paratracheal group followed by the left paratrachea and the right main bronchus LN (Table 1). The final diagnosis of the mediastinal adenopathy that was obtained by TBNA under CT scanning is reflected in Table 2. There were 31 patients with malignant mediastinal adenopathy proven by TBNA, including 2 lymphomas without a primary lung
Discussion
The TBNA technique has expanded the role of the bronchoscope from diagnosis to staging. It permits assessment of mediastinal contents at the time of diagnostic bronchoscopy. In our study, there were 31 positive aspirates from 49 patients with a sensitivity of 60%. Cystic lesions have been approachable by TBNA. Three mediastinal abscesses in our study were punctured both diagnostically and therapeutically. Fifteen patients had normal mediastinal aspirations with proven cancer of the lung. The
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Imaging-Bronchoscopic Correlations for Interventional Pulmonology
2010, Thoracic Surgery ClinicsCitation Excerpt :It has also been suggested that improved results from attempted transbronchial biopsy may result when CT fluoroscopy has been used to aid in the diagnosis of peripheral lesions (Fig. 8). To date, while there have been several small promising case series reported,19,20,22,23,47 there has been only one small randomized controlled trial24 comparing CT fluoroscopy–guided bronchoscopy with conventional bronchoscopy for the diagnosis of peripheral lesions. In this study, there was no significant difference between CT fluoroscopy–guided bronchoscopy and conventional bronchoscopy;24 however, when CT confirmed entry of the biopsy forceps or needle into peripheral lesions, the diagnostic yield did prove considerably higher.
Imaging-Bronchoscopic Correlations for Interventional Pulmonology
2009, Radiologic Clinics of North AmericaCitation Excerpt :It has also been suggested that improved results from attempted transbronchial biopsy may result when CT fluoroscopy has been used to aid in the diagnosis of peripheral lesions (Fig. 8). To date, while there have been several small promising case series reported,19,20,22,23,47 there has been only one small randomized controlled trial24 comparing CT fluoroscopy–guided bronchoscopy with conventional bronchoscopy for the diagnosis of peripheral lesions. In this study, there was no significant difference between CT fluoroscopy–guided bronchoscopy and conventional bronchoscopy;24 however, when CT confirmed entry of the biopsy forceps or needle into peripheral lesions, the diagnostic yield did prove considerably higher.