The Clinical Research Of Transbronchial Needle Aspiration In The Diagnosis Of Mediastinal And Extra Bronchial Lesions

Background: Conventional bronchoscopy for diagnosis of tracheobronchial lesions played asignificant role,but for the patients with pure mediastinal nodes or mediastinal lymphadenectasis withintrapulmonary mass,we can not find clear lesion through the conventional bronchoscopy, it is verydifficult to diagnosis definitely, the non-invasive examination such as CT or PET-CT is a better method indiagnosing mediastinal lesions, but it is limited in the hlep of therapeutic regimen,Transbronchial needleaspiration (TBNA) is the application of a special needle through the biopsy channel bronchoscope into thetrachea,bronchus and then penetrate the wall of the outer part of the cavity lesions, such asnodules,mass,inflammation to acquire cell or tissue specimens for cytology or pathology examination.Thisprocess greatly relase the pain of the patient and greatly reduce the risk of the operation,it provide a simplemethod in the diagnosis of the mediastinal and extra bronchial lesions.Objective: Compared the transbronchial needle aspiration (TBNA) with the conventional diagnostictechniques (CDT)in the diagnosis of mediastinal and extra bronchial lesions.Methods:87cases of consecutive patients (57males and30females) referred to the Department ofPulmonary Medicine,Huaihe Hospital respiratory medicine of Henan University,between September2011and October2013with mediastinal lymphadenectasis,lung mass,nodules,obstructive inflammation oratelectasis on CT, The age range was19-80yrs,were include in this study,routine bronchoscopy showed anormal bronchial lumen or extemal pressures were given TBNA.Followed TBNA,each patient hasBiopsy.Brushing and Bronchoalveolar lavage examination.We explored the diagnostic value of TBNA inthe mediastinal and extra bronchial lesions by making statistical analysis for the positive rate of the fouroperation mentioned above.TBNA was performed with Wang needle(MW-319),using electronic bronchoscope(BF-1T60;Olympus).Patients with preoperative must sign the informed consent,Following local anesthesia (lidocaine2%),introduced the electronic bronchoscope through the nose into the trachea.According tracheobronchialtree checking the bronchial carefully,provided no endobronchial lesions were identified, the mediastinal lymphaden or extrabronchial lesion was approached first by TBNA and then by Biopsy andBrush,Bronchial Washing.When the WANG needle is inserted through the working channel of thebronchoscope, it must in the retracted position,reached into the appropriate section lesion by promoting thebronchial,then applied suction.With the elimination of negative pressure,withdrawned the needlecompletely from the bronchoscope.Smeared the specimens on clean glass slides with30ml syringe,if weobtained a histological core of tissue,we should removed it to formalin solution,and then sent the specimensto the pathology department..After TBNA,Biopsy.Brushing examination and bronchoalveolar lavagewere given for each patient.Results:1.The results of conventional bronchoscopy No obvious pathological changes in the airway lumen in25patients,39patients had different degree of lumen stenosis by extra pressure.23patients had congestionand edema in mucosal.2.The results of different diagnostic techniques.2.1Results of TBNA87cases of patients,160TBNA were performed.76patients (87.3%) casesobtained positive diagnosis.69cases(79.3%) had proven malignant tumor,;Benign lesions in7cases.2.2Results of Biopsy examination of87cases, there were10(11.5%)cases had positive results, inwhich small cell carcinoma3cases,5cases with adencarcinoma,1case with squamous cellcarcinoma,1case with tuberculosis,the rests cases showed normal bronchial mucosa.2.3Rests of Bronchial Brushing examination Of87cases,13(14.9%)cases had positive results.Amongwhich,3cases showed adencarcinoma,2cases showed squamous cell carcinoma,5cases showed small cellcarcinoma,1case showed tuberculosis,2cases showed Non-specific inflammation.2.4Rests of Bronchial Washing of87cases,8(9.1%)cases had positive results,5cases showedadencarcinoma,2cases showed small cell carcionma,1case showed squamous cell carcinoma.3.The diagnostic yield of different diagnostic techniques with respect to the type of the lesion3.1In the mediastinal lymphadenectasis with congestion and edema in local mucosal:In the resultsof TBNA,21(91.3%)cases obtained positive diagnosis,in the results of Biopsy examination,6(26.1%)casesobtained positive diagnosis,in the results of Brushing examination,7(30.4%)cases obtained positivediagnosis,and in the bronchoalveolar,3(13.0%)cases obtained positive diagnosis,in this type of lesion,5 (21.7%)cases were diagnosed by TBNA alone.3.2In the mediastinal lymphadenectasis with lumen stenosis:In the results of TBNA,33(84.6%)cases obtained positive diagnosis,in the results of Biopsy examination,3(7.6%)cases obtainedpositive diagnosis,in the results of Brushing examination,5(12.8%)cases obtained positive diagnosis,and inthe bronchoalveolar,4(10.2%)cases obtained positive diagnosis,in this type of lesion,21(53.8%)cases werediagnosed by TBNA alone.3.3In the pure mediastinal lymphadenectasis:In the results of TBNA,22(88.0%)cases obtainedpositive diagnosis,in the results of Biopsy examination,1(4.0%)cases obtained positive diagnosis,in theresults of Brushing examination,1(4.0%)cases obtained positive diagnosis,and in the bronchoalveolar,1(4.0%)cases obtained positive diagnosis,in this type of lesion,21(84.0%)cases were diagnosed by TBNAalone.4.Comparison of diagnostic results between cytopahology and histopathology: The lung cancersconfirmed by biopsy and pathologically78case,and confirmed by cytology of TBNA66casae.5.The results of immunohistochemical by TBNA: The four kinds of antibody positive rate in thedifferent types of lung cancer are significantly different.6.Complications:5patients had minor bleeding in the puncture site without special treatment,3patients had excessive bleeding,they were given the dilution adrenaline through the way of pleuralperfusion to stop the bleeding,and no infection,mediastinal emphysema and other complications occurred;Conclusion: TBNA is a safe,simple and effective way in the diagnose of mediastinal and extrabronchial lesions,it has high diagnostic rate and minor injures, it is should be used as a routine examinationprocedure in the clinical work.