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* From the Division of Pulmonary and Critical Care Medicine (Drs. Garpestad, Herth, and Ernst, and Mr. Garland), Division of Thoracic Surgery (Drs. LoCicero and Thurer), and Department of Radiology (Dr. Goldberg), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Correspondence to: Armin Ernst, MD, FCCP, Director, Interventional Pulmonology, Beth Israel Deaconess Medical Center, West Campus, One Deaconess Rd, Boston, MA 02115; e-mail: aernst{at}caregroup.harvard.edu
Objective: To demonstrate the usefulness of real-time guidance with CT fluoroscopy to improve the yield of transbronchial needle aspiration (TBNA).
Design: Prospective, observational.
Setting: A tertiary-care, university-affiliated medical center.
Methods: From December 1998 to April 2000, 35 patients underwent CT fluoroscopy-guided TBNA. Patients with subcarinal and precarinal lymph nodes were only included if a previous attempt was nondiagnostic, as the initial yield in this setting with conventional TBNA is high. TBNA was performed using standard technique in a CT-scan suite. Needle location was confirmed with fluoroscopy without IV contrast being used. Specimens were evaluated on-site for adequacy.
Results: The procedure had to be aborted in three patients before TBNA could be performed. Samples were obtained in 32 patients. Samples were nondiagnostic in four patients. Adequate tissue was obtained in 28 of 32 patients (87.5%). Twenty-two patients had a specific benign or malignant diagnosis made, and 6 patients had lymphocytes only on the specimen. In follow-up, only one of these six patients proved to have a malignancy. All procedures were performed within a regular interventional CT time slot of 1 h. No TBNA side effects were noted.
Conclusion: TBNA under CT fluoroscopic guidance is easy to perform. The yield in all accessible lymph node stations is high.
Key Words: bronchoscopy • CT fluoroscopy • mediastinal lymphadenopathy • transbronchial needle aspiration
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