Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed?

Transbronchial needle aspiration has emerged as a key technique for sampling mediastinal adenopathy but variable yields are reported. To determine the number of aspirates needed to optimize yield, we prospectively studied transbronchial needle aspiration and the sequential effect of each successive specimen on diagnostic yield in 79 patients with known or suspected lung carcinoma and mediastinal adenopathy. A total of 451 aspirates were performed in 79 patients (mean, 5.7 aspirates per patient; range, 2-13) with 45 cases (57%) positive for malignancy. A cytologically positive transbronchial needle aspiration occurred with the first aspirate in 42% of patients in whom this procedure established mediastinal nodal involvement. All positive results were achieved with seven or fewer aspirates. Similar yields were obtained for small cell and non-small cell lung cancer after seven aspirates. Rapid on-site specimen cytologic evaluation was used in 55 of 79 cases (70%), with a positive diagnosis obtained in 39 of 55 cases (71%) with on-site evaluation compared with six of 24 cases (25%) performed without on-site evaluation. The data suggest there is a plateau in yield after seven transbronchial needle aspirates, which may be sufficient to obtain an optimal yield in assessing patients with lung cancer and mediastinal adenopathy.

[1]  E F Haponik,et al.  Flexible transbronchial needle aspiration for staging of bronchogenic carcinoma. , 1983, Chest.

[2]  P. Terry,et al.  Transbronchial needle aspiration in the diagnosis and staging of bronchogenic carcinoma. , 2015, The American review of respiratory disease.

[3]  D A Schenk,et al.  Transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma. , 1987, Chest.

[4]  I. Ramzy,et al.  Transbronchial fine-needle aspiration. Reliability and limitations. , 1989, American journal of clinical pathology.

[5]  D Shure,et al.  Transbronchial biopsy and needle aspiration. , 1989, Chest.

[6]  A. Mehta,et al.  Transbronchial needle aspiration for histology specimens. , 1989, Chest.

[7]  P. Strollo,et al.  Utility of the Wang 18-gauge transbronchial histology needle in the staging of bronchogenic carcinoma. , 1989, Chest.

[8]  R. Davenport.  Rapid on-site evaluation of transbronchial aspirates. , 1990, Chest.

[9]  Predictors of survival in patients treated with long-term oxygen therapy. , 1992, Respiration; international review of thoracic diseases.

[10]  C. Bolliger,et al.  Transbronchial needle aspiration in routine fiberoptic bronchoscopy. , 1992, Respiration; international review of thoracic diseases.

[11]  E. Edell,et al.  The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma. , 1993, Chest.

[12]  P. Strollo,et al.  Comparison of the Wang 19-gauge and 22-gauge needles in the mediastinal staging of lung cancer. , 1993, The American review of respiratory disease.

[13]  J. Cappellari,et al.  Education and experience improve transbronchial needle aspiration performance. , 1995, American journal of respiratory and critical care medicine.

[14]  Wang Kp,et al.  Transbronchial needle aspiration and percutaneous needle aspiration for staging and diagnosis of lung cancer. , 1995 .

[15]  S. Gasparini,et al.  Integration of transbronchial and percutaneous approach in the diagnosis of peripheral pulmonary nodules or masses. Experience with 1,027 consecutive cases. , 1995, Chest.

[16]  Jonathan M. Rubin,et al.  Endobronchial ultrasound-guided needle aspiration of mediastinal adenopathy. , 1997, American journal of respiratory and critical care medicine.

[17]  G. J. Serdá,et al.  Relevance of Training in Transbronchial Fine-Needle Aspiration Technique , 1997 .

[18]  C. Mountain,et al.  Regional lymph node classification for lung cancer staging. , 1997, Chest.

[19]  E F Haponik,et al.  Underutilization of transbronchial needle aspiration: experiences of current pulmonary fellows. , 1997, Chest.

[20]  P. Kvale,et al.  Bronchoscopy training: current fellows' experiences and some concerns for the future. , 2000, Chest.

[21]  W. Baaklini,et al.  Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. , 2000, Chest.

[22]  A. Mehta,et al.  The utility of transbronchial needle aspiration in the staging of bronchogenic carcinoma. , 2000, American journal of respiratory and critical care medicine.

[23]  T. McCain,et al.  Increasing use of bronchoscopic needle aspiration to diagnose small cell lung cancer. , 2000, Mayo Clinic proceedings.

[24]  H. Rubin,et al.  Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. , 2000, Chest.

[25]  S. Goldberg,et al.  CT fluoroscopy guidance for transbronchial needle aspiration: an experience in 35 patients. , 2001, Chest.

[26]  R. Trisolini,et al.  Role of fiberscopic transbronchial needle aspiration in the staging of N2 disease due to non-small cell lung cancer. , 2002, The Annals of thoracic surgery.