Canadian Neighbor Pharmacy: Transbronchial Needle Aspiration in the Diagnosis of Endobronchial Malignant Lesions
Transbronchial needle aspiration (TBNA) is a beneficial, safe, and minimally invasive bronchoscopic technique used in the diagnosis and staging of bronchogenic carcinoma. It was first introduced by Wang et al in the late 1970s. This method is usually performed through a flexible bronchoscope and provides cytologic or histologic sampling of mediastinal lesions that lie adjacent to the tracheobronchial tree. Previously, the utility of TBNA was restricted to mediastinal lymph node and extrabronchial lesion sampling. Its use has been expanded to complement conventional diagnostic techniques (CDT) such as bronchial washing (BW), bronchial brushing (BB), and forceps biopsy (FB) in the diagnosis of lung cancer with endobronchial lesions.
Central bronchogenic carcinoma tends to manifest in one of three patterns. The growth may be predominantly in the mucosal layer, in which case the tumor presents as a bulky, exophytic mass. It can also spread predominantly in the submucosa, with endoscopic findings consisting of erythema, loss of the normal bronchial markings, narrowing of the bronchus, or thickening of the mucosa. The third pattern is that of a predominantly peribronchial spread, in which the endoscopic findings are usually narrowing of the airway due to extrinsic compression of the bronchus. Particularly in the presence of peribronchial and submucosal lesions, diagnosis with CDT such as BW, BB, and FB is more difficult. However, applying a needle into the lesion provides access to lower layers of the bronchus and adjacent lesions. Despite its advantages in diagnosis, TBNA is still an underutilized procedure in many centers because of the risk of damage to the bronchoscope, need for experienced staff, and high cost. This is a retrospective study carried out in our clinic to investigate the diagnostic yield of TBNA and its contribution to CDT in lung cancer patients.