Chest
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (9)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cetinkaya, E.
Right arrow Articles by Yilmaz, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cetinkaya, E.
Right arrow Articles by Yilmaz, V.
(Chest. 2004;125:527-531.)
© 2004 American College of Chest Physicians

Diagnostic Value of Transbronchial Needle Aspiration by Wang 22-Gauge Cytology Needle in Intrathoracic Lymphadenopathy*

Erdogan Cetinkaya, MD; Pinar Yildiz, MD; Sedat Altin, MD and Veysel Yilmaz, MD

* From the Department of Pulmonology, Yedikule Chest Diseases and Chest Surgery Training Hospital, Istanbul, Turkey.

Correspondence to: Pinar Yildiz, MD, Vanderbilt University School of Medicine, Vanderbilt-Ingram Comprehensive Cancer Center, 2200 Pierce Ave, PRB 640, Nashville, TN 37232-6838; e-mail: pinary70{at}hotmail.com


   Abstract
TOP
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 Conclusion
 References
 
Objectives: The aim of this study was to investigate the diagnostic value of transbronchial needle aspiration (TBNA) performed with a Wang 22-gauge cytology needle in patients with mediastinal and/or hilar adenopathy.

Design: Cross-sectional study.

Setting: Tertiary care training hospital.

Patients: TBNA procedures were performed using a flexible bronchoscope and a 22-gauge Wang needle in 60 consecutive patients (36 women and 24 men; mean age, 39 ± 16 years [± SD]) who had mediastinal or hilar adenopathy identified on CT of the chest.

Results: Adequate lymph node sampling was obtained from 59 of 60 patients (98%). We were able to make a diagnosis in 45 of 60 patients (75%). TBNA was the only tool of diagnosis in 30 of the 60 patients (50%). Diagnoses included tuberculosis (n = 21), sarcoidosis (n = 21), carcinoma (n = 15), and lymphoma (n = 3). Adequate material was obtained from 20 of 21 patients with tuberculosis. The diagnosis made by TBNA was tuberculosis in 13 of 20 cases (65%). In 12 patients, diagnosis of tuberculosis was made cytologically; for the remaining 1 patient, mycobacterial culture was used. TBNA was the only diagnostic tool utilized in 8 of 20 patients with tuberculosis (40%). Diagnostic material was obtained from 16 of 21 patients with sarcoidosis (76%). In sarcoidosis, TBNA provided the only diagnostic specimen in 13 of 21 patients (62%). In all 15 patients with carcinoma (100%), diagnostic materials were obtained. Adequate but nondiagnostic samples were obtained from two patients with lymphoma, and one patient had lymphoma successfully diagnosed with TBNA. No complications were seen except minimal bleeding.

Conclusion: TBNA performed with a Wang 22-gauge cytology needle is an effective and safe way of obtaining cytologic specimens from intrathoracic lymph nodes and can rapidly provide diagnosis, both in malignant and benign mediastinal diseases. Hopefully, this technique will reduce further need for more invasive surgical procedures.

Key Words: bronchoscopy • lymphadenopathy • sarcoidosis • transbronchial needle aspiration • tuberculosis


   Introduction
TOP
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 Conclusion
 References
 
Transbronchial needle aspiration (TBNA) has been used to obtain cytologic specimens from mediastinal lymph nodes for the diagnosis and staging of bronchogenic carcinoma.1 2 However, there are limited data on nonmalignant, especially mycobacterial intrathoracic lymphadenopathy diagnosed with cytologic specimens obtained by TBNA.3 We previously reported the value of using a 19-gauge histologic needle for the differential diagnosis of intrathoracic lymphadenopathy.4 In the present study, we aimed to investigate the diagnostic value of TBNA performed with a 22-gauge Wang cytology needle, in patients with mediastinal and/or hilar adenopathy identified by CT of the chest.


   Materials and Methods
TOP
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 Conclusion
 References
 
In this prospective study from August 1998 to June 2002, TBNA procedures were performed in 60 patients (36 women and 24 men; mean age, 39 ± 16 years [± SD]) who were consecutively admitted or referred to our hospital. All patients undergoing bronchoscopy with TBNA for the diagnosis of intrathoracic lymphadenopathy without any definitive pulmonary lesions revealed by chest CT were included in our study. The final diagnoses of the patients consisted of tuberculosis (n = 21; 15 women and 6 men; mean age, 27 ± 11 years), sarcoidosis (n = 21; 16 women and 5 men; mean age, 40 ± 13 years), carcinoma (n = 15; 4 women and 11 men; mean age, 55 ± 11 years), and lymphoma (n = 3; 1 woman and 2 men; mean age, 36 ± 17 years).

Before bronchoscopy, mediastinal or hilar adenopathies were identified on the basis of chest CT (Fig 1 ). TBNA was performed with a 22-gauge Wang needle (MW-122 Mill-Rose Laboratories; Mentor, OH), using fiberoptic bronchoscopy (FOB) [BF 30 T; Olympus; Tokyo, Japan] with sampling from endobronchial or endotracheal locations as previously described by Wang.5 6 All patients underwent FOB performed by a single pulmonologist (E.C.). TBNA procedures were performed in one to four different endobronchial locations (mean, 2.3 ± 0.8 locations) according to pathologic lymph nodes in CT, and were repeated 1 to 10 times (mean, 5.3 ± 2.2 times) for each procedure according to physician’s decision. Flexible bronchoscopy was not repeated when the first procedure failed to achieve diagnosis. No pathologist was present during the procedures. TBNA procedures were performed prior to other bronchoscopic procedures to avoid false-positive results. Direct smear technique was used for preparation of TBNA specimens. Specifically, needle content was coated on a glass slide and fixed with alcohol, 95% solution, for cytologic examination. In all patients, smears were examined for the presence of acid-fast bacilli (AFB) and cultured on Lowenstein-Jensen medium.



View larger version (137K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1.. Contrast-enhanced CT of the chest showing enlargement of the subcarinal and left hilar lymph nodes in one of the patients with tuberculosis.

 
Adequate lymph node specimens were defined as those demonstrating lymphoid tissue on cytological specimens or yielding positive mycobacterium cultures. Bronchial lavage, BAL, transbronchial biopsy (TBB), and endobronchial biopsy procedures were performed as clinically indicated.

TBNA was considered to be diagnostic for mycobacterial disease if the specimen revealed granulomatous inflammatory changes with apparent necrosis or acid-fast organisms identified in smears, with Mycobacterium tuberculosis growth in Lowenstein cultures. Papanicolaou staining of TBNA cytology specimen showing a Langerhans giant cell in one of the tuberculosis patients is shown in Figure 2 . Diagnosis of tuberculosis was made by demonstration of AFB growth in Lowenstein culture (n = 3; including bronchial washing culture [n = 1] and TBNA material culture [n = 2]) and/or clinical-radiologic recovery with standard antituberculous therapy (n = 21).



View larger version (120K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2.. Papanicolaou staining of TBNA cytology sample showing Langerhans cell (original x 400).

 
If clinical and radiologic features consistent with sarcoidosis were observed and all AFB smear and culture specimen findings were negative, diagnosis was made by TBNA based on the following criteria: presence of epitheloid cell granuloma, lymphocytes, epithelioid histiocytes as clusters or palisadic groups, and multinucleated giant cells with no or minimal necrosis. Final diagnoses were made based on clinical and radiologic findings, the presence of extrapulmonary manifestations (n = 5; including erythema nodosum [n = 2], Löfgren syndrome [n = 2], and skin lesions [n = 1]), histopathologic examination of mediastinal and/or peripheral lymph node or skin lesions (n = 8), elevated CD4/CD8 ratio in BAL (CD4:CD8 ratio > 3.5; n = 6), cytopathologic specimen obtained by TBNA consistent with sarcoidosis (n = 16), and clinical and radiologic stability or regression with or without corticosteroid treatment (n = 12).

Diagnosis of malignancy was defined by the presence of malignant cells in cytologic specimens. The histology distribution was as follows: small cell carcinoma (n = 5), adenocarcinoma (n = 8), epidermoid carcinoma (n = 1), and non-small cell carcinoma (n = 1). Two of the patients with small cell carcinoma had histopathologic tissue obtained from mucosal lesions that confirmed diagnosis. Another patient with small cell carcinoma had primary tumor of the lung with metastasis to the liver. In the patient with adenocarcinoma, one patient presented with extensive bone metastasis in scintigraphy, but the primary tumor was not identified with conventional screening techniques. A second patient had lung metastasis from a primary colon carcinoma; in the other six cases, the primary tumor was not found. The patient with non-small cell carcinoma had a primary breast tumor with lung metastasis. The patient with epidermoid carcinoma had an early stage lung carcinoma resected 3 years prior to this study, and new intrathoracic lymph nodes were identified as recurrence. All cases were reviewed with cytopathologic, radiologic, clinical and bronchoscopic findings at our multidisciplinary meeting, and the patients were sent to oncology for future therapy and follow-up.

All patients underwent at least three sputum smear examinations for AFB prior to bronchoscopy, and the results of sputum smears were found to be negative. All patients were HIV negative. All patients were examined with good medical and laboratory practices according to the recommendations set forth by the Declaration of Helsinki on Biomedical Research Involving Human Subjects.7

Statistical analyses were performed with the Statistical Package Program for Social Sciences (SPSS for Windows 10.0; SPSS; Chicago, IL). Values are given as mean ± SD. Comparisons between groups were made by unpaired t test; p < 0.05 was accepted as significant.


   Results
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 Conclusion
 References
 
Adequate lymph node samples were obtained in 59 of 60 patients (98%). We were able to make a diagnosis in 45 of 59 patients (76%) whose adequate lymph node samples were obtained by TBNA. TBNA was the only diagnostic tool in 30 of 60 patients (50%). Results of TBNA and additional diagnostic methods in study patients are given in Table 1 . TBNA was targeted to different endobronchial sites (mean, 2.3 ± 0.8; minimum 1, maximum 4) according to pathologic lymph nodes identified by CT. TBNA was performed in one location in 11 patients (18%). Most of the patients needed sampling from two to three locations (24 patients for each; 80%). The procedure was performed in four different locations in the remaining one patient (2%). The number of locations utilized was not different between patients with and without diagnosis made by TBNA (2.3 ± 0.8 vs 2.1 ± 0.7; p > 0.05).


View this table:
[in this window]
[in a new window]

  		Table 1.. Results of TBNA and Additional Diagnostic Methods in Study Patients*

 
Bilateral hilar lymphadenopathy (HL) was detected in 22 patients (sarcoidosis [n = 19], tuberculosis [n = 1], and malignancy [n = 2]). Most of the patients with sarcoidosis (19 of 21 patients, 91%) had bilateral HL. In 30 patients, unilateral HL was detected by thorax CT. Eighteen of these cases (60%) were caused by tuberculosis. Only two patients with sarcoidosis had unilateral HL. The remaining 10 patients were found to have lung cancer and lymphoma. Two patients with tuberculosis and 6 patients with malignancy had enlargement of the mediastinal lymph node without HL. Diagnostic success rate by TBNA was similar between patients with and without HP. The mean purified protein derivative value was 18 ± 5 mm in patients with tuberculosis. Eleven of the 16 patients with sarcoidosis (69%) had negative purified protein derivative findings.

Adequate materials were obtained from 20 of 21 patients with tuberculosis; in 13 of these patients (65%), diagnosis was made by TBNA. Cytologic examinations revealed tuberculosis in 12 of the patients; in 1 patient, diagnosis was made with bacteriologic examination. TBNA by cytology needle provided the only diagnostic specimen in 8 of 20 patients (40%) with tuberculosis. M tuberculosis was detected in postbronchoscopic sputum and/or in bronchoscopic lavage by smear and/or culture in two patients. Four patients with tuberculosis not diagnosed by TBNA underwent mediastinoscopy for final diagnosis. For three patients who refused further invasive procedures, diagnosis was achieved by clinical-radiologic recovery with standard antituberculous therapy. Lymphadenopathies with minimal parenchymal lesions in eight patients and pleural and/or pericardial effusion in two patients were observed. Two of the patients with tuberculosis had an endobronchial abnormality, and samples that were obtained by flexible bronchoscope (bronchial biopsy and TBNA) yielded a definitive diagnosis in these two patients. One of the patients from whom adequate material was not obtained with TBNA also had a supraclavicular lymph node. Diagnosis was made with a supraclavicular lymph node biopsy in this patient. All patients confirmed to have tuberculosis were successfully treated with a short course of standard antituberculous therapy, including isoniazid, rifampin, pyrazinamide, and ethambutol.

In 16 of 21 patients with sarcoidosis (76%), diagnosis was made by TBNA. TBNA provided the only diagnostic specimen in 13 of 21 patients with sarcoidosis (62%). Löfgren syndrome accompanied the clinical course in two patients. Furthermore, hypercalcemia was observed in two cases. The diagnosis of sarcoidosis was confirmed by biopsy of subcutaneous nodules in one patient and peripheral lymphadenopathy in another patient. Mediastinoscopy was used for diagnosis in four patients and for confirmation of diagnosis in one patient. In one patient, diagnosis was made by using scalenus biopsy. Fourteen patients with sarcoidosis were at stage I (intrathoracic lymphadenopathy alone), and the remaining seven patients were at stage II (parenchymal lesions with lymphadenopathy).

Carcinoma patients had no definitive lesions by chest CT except intrathoracic lymphadenopathy. In all of the 15 carcinoma patients (100%) and 3 patients with lymphoma, adequate materials were obtained. However, in two patients (67%), diagnosis of lymphoma could not be made with cytologic examination of TBNA. Rate of diagnostic success by TBNA was similar between tuberculosis and sarcoidosis (65% vs 76%), which appeared lower than intrathoracic lymphadenopathy due to carcinoma (100%). No complications were seen other than minimal bleeding.


   Discussion
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
Conclusion
 References
 
TBNA is a safe and effective way to assess mediastinal lymphatic involvement in the diagnosis and staging of lung cancer.1 2 There is limited experience in the diagnosis of mycobacterial intrathoracic lymph nodes with cytologic specimens obtained by TBNA in HIV-negative patients.3 8 9 10 However, diagnosis is an important problem not only in HIV-positive patients with tuberculosis of intrathoracic lymph nodes but also HIV-negative patients.8 9 10 In our study, diagnoses made by TBNA were tuberculosis in 13 of 20 cases (65%). Cytologic samples obtained by TBNA were diagnostic in 12 of the 20 patients with tuberculosis, and culturing of TBNA specimens in Lowenstein medium was diagnostic in the other patient. TBNA with a cytology needle provided the only diagnostic specimen in 8 of 20 patients (40%) with tuberculosis. Our study suggests that TBNA performed using a Wang 22-gauge needle is a useful and safe method in the diagnosis of HIV-negative adult patients with intrathoracic lymph nodes due to tuberculosis. The method is valuable insofar as tuberculosis is responsible for most of the benign intrathoracic lymph node enlargements in our country.9 Garpestad and colleagues11 have shown that CT fluoroscopy-guided TBNA is very successful and effective in patients with previously nondiagnostic biopsies and lymph node stations that are less-easily accessible. Biopsies of small nodes and hilar nodes can be performed reliably.11 We believe TBNA is still underutilized and markedly depends on the physician’s skill. Dependence on CT fluoroscopy scan can increase procedure length and patient exposure to excess radiation. Although TBNA without CT fluoroscopy had a higher yield in our series, it should probably depend on the physician’s experience and the size of the lymph nodes.

Reports4 12 13 14 have addressed the capability of utilizing 18- or 19-gauge needles to collect samples suitable for histologic examination. No study was found comparing Wang 19-gauge and 22-gauge needles in the diagnosis of benign mediastinal lymph nodes. Schenk and colleagues13 have shown that the combined use of histologic and cytologic needles significantly increased the yield of TBNA vs cytologic needles in the mediastinal staging of lung cancer. However, using a large-caliber needle alone or in combination with a 22-gauge needle might result in a prolonged procedure and increased complications. The use of a direct smear preparation of TBNA materials obtained with 22-gauge needles is an effective, rapid, and simple method.15 In our study, TBNA with cytologic needles provided the only diagnostic specimen in 30 of 60 patients (50%), and diagnostic material was obtained in 45 of 59 patients (76%). According to our experience in examining intrathoracic lymph nodes, the direct smearing of specimens obtained by cytologic needle can be used as a safe, effective, and simple method for diagnosis.

Sarcoidosis is in general a benign disease; however, tissue analysis is necessary for differential diagnoses such as lymphoma, tuberculosis, and other causes of intrathoracic lymph nodes. The usual method of obtaining diagnostic tissue is TBB. However, TBB carries significant complications.16 In some cases, further invasive procedures might be needed, such as mediastinoscopy or open-lung biopsy. The technique of TBNA, as adapted by Wang et al,17 18 19 has offered a simple and successful alternative to mediastinoscopy sampling of mediastinal lymph nodes. There are some reports on the diagnostic value of TBNA with 18- and 19-gauge histologic needles for the diagnosis of intrathoracic lymph nodes in patients with sarcoidosis.4 20 21 22 23 In our study, 16 of 20 patients with sarcoidosis (76%) were successfully diagnosed by TBNA with a 22-gauge needle. Our data suggest that, also in patients with sarcoidosis, TBNA with a 22-gauge needle is an accurate diagnostic tool in the evaluation of intrathoracic lymph nodes.

The value of TBNA is particularly evident in staging and diagnosis of lung carcinoma.13 14 17 18 19 Initial reports17 18 described the use of 21- or 22-gauge needles to obtain cytology specimens, but more recent articles13 14 have addressed the utility of larger caliber needles capable of acquiring samples suitable for histologic examination.13 14 However, the false-positive rate of cytologic specimens by TBNA is very low.1 24 In our study, diagnostic material was obtained from 100% of patients with carcinoma (15 of 15 patients). Two of three patients with lymphoma provided adequate but nondiagnostic material. The addition of histologic specimens to cytologic specimens may increase the sensitivity of TBNA in staging lung cancer13 ; however, cytologic specimens alone may be sufficient for diagnosing malignant lymph nodes, with the exception of lymphoma.


   Conclusion
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 Conclusion
References
 
We conclude that TBNA with a Wang 22-gauge cytology needle is an effective and safe way to obtain cytologic specimens from intrathoracic lymph nodes and can rapidly provide a diagnosis, both in malignant and benign mediastinal disease. Hopefully, this technique will reduce further need for more invasive surgical procedures.


   Acknowledgements
 
The authors thank Nur Urer, MD, for help with cytopathologic examinations.


   Footnotes
 
Abbreviations: AFB = acid-fast bacilli; FOB = fiberoptic bronchoscopy; HL = hilar lymphadenopathy; TBB = transbronchial biopsy; TBNA = transbronchial needle aspiration

Received for publication February 28, 2003. Accepted for publication September 15, 2003.


   References
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 Conclusion
 References
 

  1. Harrow, EM, Oldenburg, FA, Jr, Lingenfelter, MS, et al (1989) Transbronchial needle aspiration in clinical practice: a five year experience. Chest 96,1268-1272[Abstract/Free Full Text]
  2. Wang, KP Flexible transbronchial needle aspiration biopsy for histologic specimens. Chest 1985;88,860-863[Abstract/Free Full Text]
  3. Baron, KM, Aranda, CP Diagnosis of mediastinal mycobacterial lymphadenopathy by transbronchial needle aspiration. Chest 1991;100,1723-1724[Abstract/Free Full Text]
  4. Cetinkaya, E, Yildiz, P, Kadakal, F, et al Transbronchial needle aspiration in the diagnosis of intrathoracic lymphadenopathy. Respiration 2002;69,335-338[CrossRef][ISI][Medline]
  5. Wang, KP Transbronchial needle aspiration to obtain histology specimen. J Bronchol 1994;1,116-122
  6. Wang, KP Transbronchial needle aspiration: how I do it. J Bronchol 1994;1,63-68
  7. Declaration of Helsinki. Recommendations guiding physicians in biomedical research involving human subjects. 41st World Medical Assembly, Hong Kong, September 1989
  8. Codecasa, LR, Besozzi, G, Cristofaro, LD, et al Epidemiological and clinical patterns of intrathoracic lymph node tuberculosis in 60 human immunodeficiency virus-negative adult patients. Monaldi Arch Chest Dis 1998;53,277-280[Medline]
  9. Baran, R, Tor, M, Tahaoglu, K, et al Intrathoracic tuberculous lymphadenopathy: clinical and bronchoscopic features in 17 adults without parenchymal lesions. Thorax 1996;51,87-89[Abstract/Free Full Text]
  10. Chang, SC, Lee, PY, Perng, RP Clinical role of bronchoscopy in adults with intrathoracic tuberculous lymphadenopathy. Chest 1988;93,314-317[Abstract/Free Full Text]
  11. Garpestad, E, Goldberg, SN, Herth, F, et al CT fluoroscopy guidance for transbronchial needle aspiration. Chest 2001;119,329-332[Abstract/Free Full Text]
  12. Mehta, AC, Kavuru, MS, Meeker, DP, et al Transbronchial needle aspiration for histology specimens. Chest 1989;96,1228-1232[Abstract/Free Full Text]
  13. Schenk, DA, Chambers, SL, Derdak, S, et al Comparison of the Wang 19 gauge and 22 gauge needles in the mediastinal staging of lung cancer. Am Rev Respir Dis 1993;147,1251-1258[ISI][Medline]
  14. Schenk, DA, Strollo, PJ, Pickard, JS, et al Utility of the Wang 18-gauge transbronchial histology needle in the staging of bronchogenic carcinoma. Chest 1989;96,272-274[Abstract/Free Full Text]
  15. Wang, KP, Selcuk, ZT, Erozan, Y Transbronchial needle aspiration for cytology specimens. Monaldi Arch Chest Dis 1994;49,265-267[Medline]
  16. Unger, M, Sterman, D Bronchoscopy, transthoracic needle aspiration, and related procedures. Fishman’s pulmonary diseases and disorders 1998,589-606 McGraw-Hill. New York, NY:
  17. Wang, KP, Marsh, BR, Summer, WR, et al Transbronchial needle aspiration for diagnosis of lung cancer. Chest 1981;80,48-50[Abstract/Free Full Text]
  18. Wang, KP, Brower, R, Haponik, EK, et al Flexible transbronchial needle aspiration for staging of bronchogenic carcinoma. Chest 1983;84,571-576[Abstract/Free Full Text]
  19. Wang, KP Transbronchial needle aspiration and percutaneous needle aspiration for staging and diagnosis of lung cancer. Clin Chest Med 1995;16,535-552[ISI][Medline]
  20. Leonard, C, Tormey, V, Lennon, A, et al Utility of Wang transbronchial needle biopsy in sarcoidosis. Ir J Med Sci 1997;166,41-43[Medline]
  21. Wang, KP, Fuenning, C, Johns, CJ, et al Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis. Ann Otol Rhinol Laryngol 1989;98,298-300[ISI][Medline]
  22. Kelly, SJ, Wang, KP Transbronchial needle aspiration. J Thorac Imaging 1987;2,33-40[Medline]
  23. Morales, CF, Patefield, AJ, Strollo, PJ, et al Flexible transbronchial needle aspiration in the diagnosis of sarcoidosis. Chest 1995;106,709-711
  24. Schenk, DA, Bower, JH, Bryan, CL, et al Transbronchial needle aspiration staging of bronchogenic carcinoma. Am Rev Respir Dis 1986;134,146-178[ISI][Medline]



This article has been cited by other articles:


Home page
 ChestHome page
D. Baram, R. B. Garcia, and P. S. Richman
Impact of Rapid On-Site Cytologic Evaluation During Transbronchial Needle Aspiration
Chest, August 1, 2005; 128(2): 869 - 875.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (9)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cetinkaya, E.
Right arrow Articles by Yilmaz, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cetinkaya, E.
Right arrow Articles by Yilmaz, V.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS