Diagnostic Value of Transbronchial Needle Aspiration in Mediastinum Diseases
|Keywords||Lung cancer Bronchoscopy Mediastinal lymph node TBNA|
Objective:To evaluate the value of transbronchial needle aspiration (TBNA) in the diagnosis of mediastinum and pulmonary diseases.Methods:119 consecutive patients (72 males and 47 females) referred to the Department of Pulmonary Medicine, Shandong Provincial Hospital, between August 2007 and October 2009 with mediastinal lymphadenectasis, extrabronchial occupying lesions on CT, were included in this study. The age range was 17-76 yrs. We have not included any cases with concomitant endobronchial lesions.TBNA was performed with Wang needle, using electronic bronchoscope (BF-240、260;Olympus).Following local anesthesia (lidocaine 2%), introduced the electronic bronchoscope transnasally. After a careful examination of the bronchial, provided no endobronchial lesions were identified, the mediastinal lymphaden or extrabronchial lesion was approached first by TBNA and then by brush. Inserted the WANG needle in the retracted position through the work channel of the bronchoscope, reached the lesion by pushing the needle into the corresponding segmental bronchus, then applied suction. Direct smear technique was used for preparation of TBNA specimens. Specifically, needle content was coated on a glass slide and fixed, for cytologic examination. TBNA procedures were repeated at least 2 times every lesion to increase the positive rate.Results:1. The results of routine bronchoscopy:The tunica mucosa bronchiorum were integrated in all the 119 cases, neoplasm, ulcer,erosion and active hemorrhage were not found;the positive rate of the brush was 13.45% (16/119).Of the 49 patients with simple mediastinal lymphadenectasis, the tunica mucosa bronchiorum and lumens were completely normal in 36 cases;lightly compressed changes of the bronchus were found in 103cases.During the 63 patients with combined lung disease and mediastinal lymphadenectasis,29 cases showed indirect signs of extrabronchial lesions,10 cases found bronchial mucosa swollen, hyperemic,24 cases did not find any abnormal signs.7 cases of extrabronchial dieases, low-degree stenosis in 2cases.7cases did not find any abnormal signs.2. The results of TBNA:96 of 119 cases reached the final diagnosis by TBNA, the diagnostic yield was 80.67%(96/119)39 of the 49 patients with simple mediastinal lymphadenectasis, reached the final diagnosis, the diagnostic yield was 75.95%; 51 of 63 patients with combined lung disease and mediastinal lymphadenectasis, reached the final diagnosis, the diagnostic yield was 80.95%; 6 cases of extrabronchial dieases,7 cases got final diagnosis, the diagnostic yield was 85.71%.Conclusions:①TBNA has its own unique superiority in the diagnosing of simple mediastinal lymphadenectasis and in the staging of lung cancer, has high sensitivity, can partly take the place of the mediastinoscopy.②TBNA could get the final diagnosis of most of extrabronchial lesions which routine bronchoscopy(brush smear,biopsy) can not even get the specimen.③TBNA is generally more convenient, less risky, and less expensive for diagnosing lung diseases.