Transbronchial needle aspiration cytology (TBNA) in endobronchial lesions: a valuable technique during bronchoscopy in diagnosing lung cancer and it will decrease repeat bronchoscopy
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Lung cancer is the leading cause of cancer deaths around the world. Globally, lung cancer is the largest contributor to new cancer diagnosis and to death from cancer. Various conventional diagnostic techniques (CDTs) such as endobronchial forcep biopsy (FB), bronchial washing (BW) and bronchial brushing (BB), and transbronchial needle aspiration cytology (TBNA) are employed during fiber-optic bronchoscopy.
This is a prospective study conducted between June 2012 and September 2013 at Bronchoscopy unit of MIMSR Medical College Latur, India, to find the role of TBNA in exophytic endobronchial lesions in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BB, BW and FB, and included 150 patients on the basis of clinical and radiological features of malignancy. In exophytic endobronchial lesions, predominant endoscopic findings were cauliflower, polypoidal-like or nodular or multinodular endobronchial growth. TBNA, FB, BB and BW were performed in all the cases during FOB. Histopathological and cytological examinations of specimens were performed at Pathology department. The statistical analysis was done using chi-square test.
Total 150 patients, between age group 24–80 years, mean age was 57.93 years, male population constitutes 86.17 % of total. 76.14 % cases were smoker of them 61.87 % cases having history of >40 pack years. Commoner symptoms were cough (91.33 %), hemoptysis (54.00 %) and chest pain (46.66 %), and mass lesion (40.66 %), hilar opacity (31.33 %) and collapse segmental/lobar (29.33 %) were commoner radiological abnormalities. Yield of TBNA, CDT and TBNA plus CDT in exophytic lesions is 60.66, 79.33 and 84.66 %, respectively, in diagnosis of lung malignancies (P < 0.001). Sensitivity of forcep biopsy and TBNA in diagnosing lung malignancy was 88.18 and 71.65 %, respectively (P < 0.01). FOB-related hypoxemia documented in two cases and minor bleeding in six cases. Other complications such as significant bleeding, pneumothorax and death were not seen. Minor bleeding was seen with forcep biopsy mainly in 4.0 % cases. TBNA has decreased repeat procedure, decreases cost for diagnosis. IHC on TBNA specimens had increased histological-type confirmation.
Transbronchial needle aspiration is a beneficial, safe and minimally invasive bronchoscopic technique with insignificant side effect in the diagnosis bronchogenic carcinoma. TBNA considered safe, especially when fleshy vascular endobronchial growth is present and risk of bleeding is high with forcep biopsy. Inadequate tissue sampling due to the presence of necrosis, blood clot over the lesion and formation of crush artifacts by FB makes TBNA valuable in these lesions. TBNA will definitely decrease need for repeat bronchoscopy.
KeywordsTBNA Bronchoscopy Lung cancer Endobronchial lesions
- Bollinger CT, Plekker D, Koegelenberg CFN (2010) Different techniques in bronchoscopy. Eur Respir Mon 45:1–17Google Scholar
- Choudhry MK, Rasul S, Iqbal ZH, Qureshi SS, ul-Haq M, Hussain G, Akhtar AM (1999) Fiberoptic bronchoscopy: Role in the diagnosis of bronchogenic carcinoma. Biomedica 1999(14):32–36Google Scholar
- Dasgupta A, Minai OA, Mehta AC (2000) Transbronchial needle aspiration of central and peripheral lesions. In: Bollinger CT, Mathur PN (eds) Interventional bronchoscopy. Karger, Basel, pp 66–70Google Scholar
- Harras A, Page H (1996) The cancer statistics branch. In: Cancer rates and risks, 4th edn. National Institutes of Health, BethesdaGoogle Scholar
- Lachman MF, Schofield K, Cellura K (1999) Bronchoscopic diagnosis of malignancy in the lower airway: a cytologic review. Acta Cytol 39:1148–1151Google Scholar
- Time Trends in Cancer Incidence Rates 1982–2005, published by the National Cancer Registry Programme (ICMR), BangaloreGoogle Scholar
- British Thoracic Society guidelines for advanced diagnostic and therapeutic flexible bronchoscopy in adults (2011). Thorax 66(3)Google Scholar
- Verma SK, Shrivastav AN, Prasad R (2011) Study of fiberoptic bronchoscope in endoscopically visible bronchial carcinoma. Int Infect Dis 1:7Google Scholar
- (2005) Effectiveness of transbronchial needle aspiration in the diagnosis of exophytic endobronchial lesions and submucosal/peribronchial diseases of the lung. Lung Cancer 50(2):221–622. Epub 19 Jul 2005Google Scholar