What is the role of transbronchial needle aspiration (TBNA) in the workup of secondary lung cancer?

Updated: Feb 08, 2019
  • Author: Daniel S Schwartz, MD, MBA, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Bronchoscopy with transbronchial needle aspiration (TBNA) for mediastinal lymphadenopathy or peripheral lung lesions, forceps biopsy, brush biopsy, brush-needle biopsy, bronchial aspirate, bronchial washing, or bronchoalveolar lavage (BAL) is used for the diagnosis of endobronchial tumor, lymphangitic cancer, and pulmonary nodule(s), with decreasing order of yield.

The overall yield of noninvasive bronchoscopic specimens (ie, bronchial aspirates, bronchial washings, BAL) for diagnosis of peripheral lesions is just less than 50%. The highest yield of BAL is in lymphangitic carcinomatosis.

The diagnostic yield of fiberoptic bronchoscopy depends on the lesion location and size, the character of the border, and the ability to perform all sampling methods. Diagnostic yield for lesions less than 2 cm in diameter is 54%, compared with 80% for those more than 3 cm in diameter. For lesions located in the lower-lobe basilar segments or in the upper-lobe apical segments, yield is 58%, compared with 83% for other locations, and for lesions with sharp borders, the yield is 54%, compared with 83% for lesions with fuzzy borders. Only one of the sampling methods was positive in 24% of bronchoscopies.

The overall yield of invasive bronchoscopic specimens for diagnosis of peripheral lesions is 52% for brush, 57% for transbronchial biopsy, and 51% for transbronchial needle aspiration.

TBNA with PET

Combining TBNA with PET has been shown to obviate the need for mediastinoscopy for mediastinal staging of non-small cell lung cancer with mediastinal lymphadenopathy in most patients.

In a retrospective study of patients with enlarged mediastinal lymph nodes, the combination of TBNA and PET demonstrated higher sensitivity, negative predictive value, and accuracy than did either modality alone. The study used histopathology by surgical lymph node dissection as the criterion standard and found that the combined TBNA and PET scan had 100% sensitivity, 94% specificity, 79% positive predictive value, 100% negative predictive value, and 95% accuracy in the detection of malignant lymph nodes. For PET alone, these rates were 68%, 89%, 46%, 95%, and 86%, respectively; for TBNA alone, these rates were 54%, 100%, 100%, 91%, and 92%, respectively.


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