Introduction:
Transbronchial needle aspiration (TBNA) is a beneficial, safe and
minimally invasive bronchoscopic technique used in the diagnosis and
staging of bronchogenic carcinoma. Several studies had proved a
statistically significant difference in the diagnosis of bronchogenic
carcinoma after addition of TBNA to conventional diagnostic techniques
(CDT) such as bronchial washing (BW), bronchial brushing (BB) and
forceps biopsy (FB) in the diagnosis of lung cancer.
Aim of the work:
This study was done to evaluate the role of transbronchial needle
aspiration (TBNA) in the diagnosis of patients with bronchogenic
carcinoma and comparing the results with other conventional diagnostic
techniques.
Patients and methods:
The study was conducted on 20 patients with clinical and/or radiological
suspicion of bronchogenic carcinoma .They were 12 males (60%) and 8
females (40%). Their ages ranged from 42 to 74 years with a mean age of
57.9 years,11 patients (55%) were cigarette smokers and 9 patients (45%)
were non smokers .They were admitted to Chest Department, Benha
University Hospital in the period between March 2009 and March 2010.
Patients’ selection was based on:
Inclusion criteria:
1. Patients found to have peribronchial or submucosal disease
on bronchoscopy or mediastinal lymphadenopathy on
computed tomography.
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2. Patients with bronchoscopic picture of subcarinal widening
or extraluminal compression with or without endobronchial
lesions or masses.
Exclusion criteria:
1. Uncooperative patients.
2. The presence of uncorrectable coagulation disorder.
3. Life-threatening arrhythmias or refractory hypoxemia.
4. Inaccessible group of lymph node as prevascular lymph
nodes (para-aortic or retrocaval) for fear of major
complications.
5. Patients with unstable angina or recent myocardial
infarction.
All patients were subjected to the following:
1. Full history taking.
2. Complete clinical examination.
3. Chest X- ray (postero-anterior and lateral views).
4. Computed tomographgy of the chest with contrast.
5. Routine laboratory investigations as CBC, liver and kidney
functions and ESR.
6. Fiberoptic bronchoscopy for inspection of the tracheobronchial tree
and biopsy using TBNA and/or other sampling methods such as
bronchial washings and forceps biopsy.
7. Histopathological and cytological examination of the obtained
specimens.
8. Some patients needed other investigations to confirm or reach the
final diagnosis such as:
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113
Percutaneous transthoracic CT guided biopsy for one case of
adenocarcinoma (in which TBNA revealed lymphocytic
infiltration).
Pleural fluid cytology in one case of adenocarcinoma (in
which TBNA revealed epithelial hyperplasia )
This study revealed the following results:
The diagnostic yield of bronchial wash was (30%).
The diagnostic yield of forceps biopsy was (45%).
The diagnostic yield of TBNA was (85%).
Addition of TBNA to the conventional diagnostic methods
increased the diagnostic yield from (85%) to (90%). |
