Diagnostic Value Of Transbronchial Needle Aspiration In Mediastinum And Pulmonary Diseases

Objective: To evaluate the value of transbronchial needle aspiration (TBNA) in the diagnosis of mediastinum and pulmonary diseases.Methods: 89 consecutive patients (59 males and 30 females) referred to the Department of Pulmonary Medicine, Shandong Provincial Hospital, between March 2005 and October 2006 with mediastinal lymphadenectasis, extrabronchial occupying lesions on CT, were included in this study. The age range was 15～78 yrs. We have not included any cases with concomitant endobronchial lesions.TBNA was performed with Wang needle, using electronic bronchoscope (BF-240;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 89 cases, neoplasm, ulcer ,erosion and active hemorrhage were not found;the positive rate of the brush was 12.36%(11/89).Of the 22 patients with simple mediastinal lymphadenectasis, the tunica mucosa bronchiorum and lumens were completely normal in 13 cases;lightly compressed changes of the bronchus were found in 9 cases.During the 49 patients with combined lung disease and mediastinal lymphadenectasis,29 cases showed indirect signs of extrabronchial lesions, 13 cases found bronchial mucosa swollen, hyperemic, 7 cases did not find any abnormal signs.18 cases of extrabronchial dieases, the lumens were locked in 2 cases, half-locked in 9 cases, low-degree stenosis in 7 cases.2. The results of TBNA:74 of 89 cases reached the final diagnosis by TBNA, the diagnostic yield was 83.15% (74/89) .18 of the 22 patients with simple mediastinal lymphadenectasis, reached the final diagnosis, the diagnostic yield was 81.82%; 42 of 49 patients with combined lung disease and mediastinal lymphadenectasis, reached the final diagnosis, the diagnostic yield was 85.71%; 18 cases of extrabronchial dieases, 14 cases got final diagnosis, the diagnostic yield was 77.78%.Conclusions:(1) TBNA 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. (2) TBNA could get the final diagnosis of most of extrabronchial lesions whichroutine bronchoscopy( brush smear,biopsy) can not even get the specimen. (3) TBNA is generally more convenient, less risky, and less expensive for diagnosing lung diseases.