Chest
Volume 114, Issue 1, July 1998, Pages 36-39
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Clinical Investigations
CT Scan Directed Transbronchial Needle Aspiration Biopsy for Mediastinal Nodes

https://doi.org/10.1378/chest.114.1.36Get rights and content

Study objectives

This study was performed to determine whether transbronchial needle aspiration (TBNA) biopsy under CT guidance can increase its diagnostic yield so that this technique can be used for staging of lung cancer at our institution.

Study design

After an initial unacceptable low yield of TBNA on the first 10 patients (20% positive), we switched the biopsy procedure from the bronchoscopy suite to the CT room. After each passage of the needle to the mediastinum lymph node, CT scan was performed to locate the tip of the needle. If the initial attempt was not successful, TBNA was repeated at the same setting until CT documented that the tip of the needle was exactly inside the lymph node.

Result

A total of 49 patients with 69 mediastinum adenopathies were enrolled in this study. There were 31 patients with malignant mediastinal adenopathy proven by TBNA (60% sensitivity). Fifteen patients showed normal results of needle aspiration despite the presence of primary lung cancer. Three patients showed mediastinal abscesses.

Conclusion

Despite numerous successful reports in the literature, the general application of the TBNA procedure appears to be limited because of its low sensitivity, although this could be due to numerous factors. However, using CT guidance to be sure that the tip of the needle is exactly inside the node can increase its sensitivity markedly. It may also increase the specificity of normal results of TBNA biopsy.

Section snippets

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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