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Weber, MD* From the Division of Pneumology (Drs. Reichenberger, Weber, Tamm, Bolliger, Perruchoud, and Solèr), Department of Internal Medicine, and the Institute of Pathology (Dr. Dalquen), University Hospital Basel, Basel, Switzerland.
Correspondence to: Markus Solèr, MD, FCCP, Division of Pneumology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
Background: Transbronchial needle aspiration (TBNA) is a bronchoscopic sampling technique used for the diagnostic workup of mediastinal lymph nodes, but the value of its routine use in evaluating peripheral pulmonary lesions is not yet firmly established.
Design: Retrospective analysis of routine diagnostic bronchoscopies.
Setting: University teaching hospital.
Patients and methods: One hundred seventy-two consecutive patients (126 with malignant and 46 with nonmalignant disease) who underwent bronchoscopy for a peripheral pulmonary lesion.
Results: In 87 patients (51%), a final diagnosis was established by bronchoscopy; diagnoses included 81 malignant lesions (69 lung cancer and 12 pulmonary metastases) and 6 benign lesions (all tuberculosis). TBNA was used in 152 of the 172 patients (89%). Other endoscopic techniques included bronchial washing (100%), bronchial brushing (45%), and transbronchial biopsy (TBB) (27%). Concerning the different bronchoscopic sampling techniques, TBNA showed a positive result in 35% of cases, in comparison to 17% for TBB, 22% for bronchial washing, and 30% for bronchial brushing. While TBNA was diagnostic in 27.5% of the malignant lesions < 3 cm in diameter, the success rate in lesions > 3 cm was 65.5% (p = 0.03). Endoscopy-related complications included pneumothorax (n = 1), self-limiting bleeding (n = 12), prolonged coughing (n = 2), and vasovagal reactions (n = 2). None of these complications required further treatment.
Conclusion: TBNA is an effective bronchoscopic sampling technique in the diagnosis of peripheral pulmonary lesions. In our study, the use of TBNA increased the diagnostic yield of bronchoscopy from 35 to 51% without additional risk. The use of TBNA in the clinical routine should be encouraged.
Key Words: bronchoscopy • peripheral pulmonary lesion • transbronchial needle aspiration
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