Chest
Volume 125, Issue 2, February 2004, Pages 527-531
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Clinical Investigations
LUNG BIOPSY
Diagnostic Value of Transbronchial Needle Aspiration by Wang 22-Gauge Cytology Needle in Intrathoracic Lymphadenopathy

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Objectives

The aim of this study was to investigate the diagnostic value of transbronchial needle aspiration (TBNA) performed with a Wang 22-gauge cytology needle in patients with mediastinal and/or hilar adenopathy.

Design

Cross-sectional study.

Setting

Tertiary care training hospital.

Patients

TBNA procedures were performed using a flexible bronchoscope and a 22-gauge Wang needle in 60 consecutive patients (36 women and 24 men; mean age, 39 ± 16 years [± SD]) who had mediastinal or hilar adenopathy identified on CT of the chest.

Results

Adequate lymph node sampling was obtained from 59 of 60 patients (98%). We were able to make a diagnosis in 45 of 60 patients (75%). TBNA was the only tool of diagnosis in 30 of the 60 patients (50%). Diagnoses included tuberculosis (n = 21), sarcoidosis (n = 21), carcinoma (n = 15), and lymphoma (n = 3). Adequate material was obtained from 20 of 21 patients with tuberculosis. The diagnosis made by TBNA was tuberculosis in 13 of 20 cases (65%). In 12 patients, diagnosis of tuberculosis was made cytologically; for the remaining 1 patient, mycobacterial culture was used. TBNA was the only diagnostic tool utilized in 8 of 20 patients with tuberculosis (40%). Diagnostic material was obtained from 16 of 21 patients with sarcoidosis (76%). In sarcoidosis, TBNA provided the only diagnostic specimen in 13 of 21 patients (62%). In all 15 patients with carcinoma (100%), diagnostic materials were obtained. Adequate but nondiagnostic samples were obtained from two patients with lymphoma, and one patient had lymphoma successfully diagnosed with TBNA. No complications were seen except minimal bleeding.

Conclusion

TBNA performed with a Wang 22-gauge cytology needle is an effective and safe way of obtaining cytologic specimens from intrathoracic lymph nodes and can rapidly provide diagnosis, both in malignant and benign mediastinal diseases. Hopefully, this technique will reduce further need for more invasive surgical procedures.

Section snippets

Materials and Methods

In this prospective study from August 1998 to June 2002, TBNA procedures were performed in 60 patients (36 women and 24 men; mean age, 39 ± 16 years [± SD]) who were consecutively admitted or referred to our hospital. All patients undergoing bronchoscopy with TBNA for the diagnosis of intrathoracic lymphadenopathy without any definitive pulmonary lesions revealed by chest CT were included in our study. The final diagnoses of the patients consisted of tuberculosis (n = 21; 15 women and 6 men;

Results

Adequate lymph node samples were obtained in 59 of 60 patients (98%). We were able to make a diagnosis in 45 of 59 patients (76%) whose adequate lymph node samples were obtained by TBNA. TBNA was the only diagnostic tool in 30 of 60 patients (50%). Results of TBNA and additional diagnostic methods in study patients are given in Table 1. TBNA was targeted to different endobronchial sites (mean, 2.3 ± 0.8; minimum 1, maximum 4) according to pathologic lymph nodes identified by CT. TBNA was

Discussion

TBNA is a safe and effective way to assess mediastinal lymphatic involvement in the diagnosis and staging of lung cancer.12 There is limited experience in the diagnosis of mycobacterial intrathoracic lymph nodes with cytologic specimens obtained by TBNA in HIV-negative patients.38910 However, diagnosis is an important problem not only in HIV-positive patients with tuberculosis of intrathoracic lymph nodes but also HIV-negative patients.8910 In our study, diagnoses made by TBNA were tuberculosis

Conclusion

We conclude that TBNA with a Wang 22-gauge cytology needle is an effective and safe way to obtain cytologic specimens from intrathoracic lymph nodes and can rapidly provide a diagnosis, both in malignant and benign mediastinal disease. Hopefully, this technique will reduce further need for more invasive surgical procedures.

ACKNOWLEDGMENT

The authors thank Nur Urer, MD, for help with cytopathologic examinations.

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