Is LN1cm Still A Cutoff Size For TBNA?

Background:Transbronchial fine-needle aspiration (TBNA) is a safe, easy, noninvasive, inexpensive and simple technique for sampling hilar lymph nodes, mediastinal nodes, disease of the submucosa, peripheral pathologies and parenchymal disease and near airways masses. Transbronchial needle aspiration (TBNA) is used in the assessment of enlarged hilar and mediastinal lymph nodes and submucosal lesions. For more than three decades it had been there and even with invent of EBUS-TBNA, it’s still there.Purpose:To determine the significance of aspirating mediastinal and hilar LN less than1cm short axis diameter.Methods:A retrospective analysis of406patients were done in second affiliated teaching hospital of Zhejiang university in patients who had undergone TBNA for hilar and mediastinal lymphadenopathies between May to December2013. Among the total of406patients only those with mediastinal and hilar LN with less than1cm short axis diameter were included in the study. Two different bronchoscopists preformed TBNA. All the cytology and histology were obtained with19and22gauge WANG needle. Results were classified as either malignant or non-malignant (lymphoid cell with or without bronchial mucosal cells and serum) and non-significant aspiration.Results:A total of406patients with mediastinal and hilar lymphadenopathy who underwent TBNA were done retrospective study.36/406patients were found to have enlarged mediastinal and hilar lymph nodes enlargement with a short axis diameter less than1cm. The samples were send for histology and cytological analysis. Bronchoscopy findings were found to be normal in15/36patients even though TBNA was performed. TBNA was performed in36cases, among which18/36(50%) cases were found to be positive for malignancy,9/36(25%) cases was found to have normal analysis demonstrating lymphocytes with or without bronchial mucosal cells and serum and9/36(25%) were found to have inadequate samples. A total of18malignant cases were further classified as different types of lung cancer and among which3of the malignant cases could not be traced back, which were just labeled as unclassified lung cancers. The final results in numbers were adenocarcinoma (6), squamous cell cancer (3), large cell cancer (1) and SCLC (5). The highest numbers of malignancy were found in age group56to65years.Conclusion:Keeping in mind all these significant aspirations of mediastinal LN less than1cm short axis diameter, it might thus be time to further reconsider that it’s essential to puncture those LNs since it might be malignant too irrespective of whether it is radiologically enlarged or not during chest CT imaging. Therefore, in suspected patients sample all those LNs that are possible to puncture.