Chest

Chest

Volume 119, Issue 2, February 2001, Pages 329-332
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Clinical Investigations
Lung Cancer
CT Fluoroscopy Guidance for Transbronchial Needle Aspiration: An Experience in 35 Patients

https://doi.org/10.1378/chest.119.2.329Get rights and content

Objective

To demonstrate the usefulness of real-timeguidance with CT fluoroscopy to improve the yield of transbronchialneedle aspiration (TBNA).

Design

Prospective, observational.

Setting

A tertiary-care, university-affiliated medical center.

Methods

From December 1998 to April 2000, 35 patients underwent CTfluoroscopy-guided TBNA. Patients with subcarinal and precarinal lymphnodes were only included if a previous attempt was nondiagnostic, asthe initial yield in this setting with conventional TBNA is high. TBNAwas performed using standard technique in a CT-scan suite. Needlelocation was confirmed with fluoroscopy without IV contrast being used. Specimens were evaluated on-site for adequacy.

Results

The procedure had to be aborted in three patientsbefore TBNA could be performed. Samples were obtained in 32 patients. Samples were nondiagnostic in four patients. Adequate tissue wasobtained in 28 of 32 patients (87.5%). Twenty-two patients had aspecific benign or malignant diagnosis made, and 6 patients hadlymphocytes only on the specimen. In follow-up, only one of these sixpatients proved to have a malignancy. All procedures were performedwithin a regular interventional CT time slot of 1 h. No TBNA sideeffects were noted.

Conclusion

TBNA under CTfluoroscopic guidance is easy to perform. The yield in all accessiblelymph node stations is high.

Section snippets

Materials and Methods

Beth Israel Deaconess Medical Center is a university-basedteaching hospital and tertiary referral institution with an activemultidisciplinary thoracic oncology center. Bronchoscopic TBNA isroutinely performed in patients with mediastinal lymphadenopathy.

Results

Thirty-five patients were prepared to undergo TBNA (see Table 1for demographics). Of these patients, 16 were women and 19 were men. The mean age was 62.3 years (range, 31 to 86 years). The procedurecould not be completed in three patients. The procedure had to beaborted in two patients for wheezing and hypoxia, and in one patientfor bleeding after endobronchial biopsy precluded the planned TBNA.

Thirty-two procedures involving multiple LN locations were evaluatedfor this report. All procedures

Discussion

TBNA is a valuable but underused bronchoscopic procedure. Ifsuccessfully performed, it may spare patients additional, more invasiveprocedures or surgery. As conventional TBNA requires accessing LNswithout direct visualization, the yield in less-experienced hands canbe suboptimal.

Conventional CT guidance can increase the yield of the procedure, asshown by Rong and Cui,4 but criticism of that studyincluded the low yield at baseline and the still-suboptimal yield withradiologic imaging.

In our

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Copyright © 2001 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.