The Value Of Transbronchial Needle Aspiration In The Diagnosis Of Extra Bronchial Lesions

Objective Due to most extra bronchial lesions haven't violated bronchial mucosa, it is difficult for Conventional Bronchoscope to obtain effective specimens. So the positive rate for Conventional Bronchoscope is relatively low. Transbronchial needle aspiration (TBNA) is available in penetrating the airway wall of trachea through a special flexible puncture needle with a catheter, acupuncturing and aspirating the lesions(e.g. nodules, masses,swollen lymph nodes etc.) to acquire cell or tissue specimens for cytology or pathology examination. In this paper,87patients with CT scan showed mediastinal or lung mass, nodules, obstructive inflammation or atelectasis, conventional bronchoscopy showed a normal bronchial lumen or only stenosis by external pressure were given TBNA. Followed TBNA, each patient has Brushing and Biopsy examination. We explored the diagnostic value of TBNA in extra bronchial lesions by making statistical analysis for the positive rate of the three operation mentioned above.Methods1.Preoperative preparations Drink and food were forbidden for 4 hours before operation; Examinations such as:electrocardiogram, blood test,blood coagulation, the virus family, blood pressure measure are essential. Patients with normal check results mentioned above were asked to sign in the informed consent form.After successful anesthesia with 2% Lidocaine, requested patients to lie on the operation bed, give oxygen inhalation and continuous blood oxygen saturation(SaO2) monitor.2. Operation procedureIntroduced the Bronchoscope into airway via nasal route; Identified the puncture site,angle and depth according to the CT scan and direct vision by Bronchoscope, then the needle was introduced into the working channel,when it arrived at the intended position, penetrated it vertically into the lesion employing pushing method combining with jabbing and cough method(piercing depth of 1.0-1.5cm),making sure the needle be completely imbedded. Then pulled out the needle core. Applying suction at the proximal suction port, the negative pressure produced allowed cell or tissue to be trapped inside the needle chamber.Keeping aspiration for 30-40s. Twitch-ed back and forth from different directions to increase the opportunity of specimen's acquiring under the condition of ensuring the needle not get out of the bronchial wall. Each patients underwent TBNA 1-3 sites, puncturing 2-3 times per site. With the elimination of negative pressure, withdrawned the needle completely from the bronchoscope. Smeared the specimens directly, and then sent the smears to cytology laboratory for examination. After TBNA, Brsuing and Biopsy examination were given for each patient.3. Statistical Methods Using x 2 test for statistical analysis.Results1. The results of conventional bronchoscope 43 patients had different degrees of lumen stenosis by external pressure(Figure 3-4); 27 patients showed normal bronchial lumen and mucosa; 17 cases had congestion and edema in local mucosal.2. Results of TBNA 87 patients underwent TBNA in 167 sites in total,82 patients (94.3%) cases obtained positive diagnosis.75 cases (86.2%) had proven malignant tumor, in which adenocarcinoma had 32 cases (Figure 5),20 cases with Small cell undifferentiated carcinoma (Figure6),11 cases with squamous cell carcinoma,5 cases with large cell undifferentiated carcinoma, lymphoma in 2 cases,5 patients with malignant tumors difficult to classify; Benign lesions in 7 cases, as five cases of sarcoidosis,2 cases with tuberculosis; Non-specific inflammation in 5 cases.3. Results of Brushing examination Of 87 patients, only 4 cases (4.60%)had positive results. Among which,3 cases showed squamous cell carcinoma,1 case showed tuberculosis.4. Results of Biopsy examination Only 21cases showed chronic inflammation; the rest 66 cases showed normal bronchial mucosa.5. Statistical analysis Results:Comparison of the three methods, the positive rate of TBNA group was significantly higher than brushing and biopsy group (p<0.01).6. Complications:Except eight cases had minor bleeding in the puncture site without special treatment, no infection, mediastinal emphysema and other complications occurred; All patients can well tolerate TBNA.Conclusion TBNA is a safe, simple and effective way for diagnosing extra bronchial lesions with a high diagnostic rate and minor injuries. It is worthy to be popularized in clinic work.