Transbronchial needle aspiration of central and peripheral nodules

Wang and Terry first described the technique of sampling of mediastinal lymph nodes using a flexible bronchoscope (FB) in 1983. Since then, the scope of transbronchial needle aspiration (TBNA) has increased enormously, and its value for diagnosis of central and peripheral lung lesions, even in the absence of endobronchial disease, is now recognized. Improvements in the diagnostic yield of TBNA aspirates, and increasing knowledge of predictors of a positive aspirate, has reduced the need for mediastinoscopy, and occasionally thoracotomy, with benefits in terms of reduced healthcare costs and improved patient welfare. Despite the fact that TBNA is a minimally invasive procedure, also for the staging of lung cancer, it unfortunately remains underutilized. This review aims to give the reader an overview of the indications, outcome data, technical considerations, and advantages of routinely performing TBNA. The technical suggestions to improve the yield from TBNA will hopefully provide greater understanding of this modality and help the pulmonologist to incorporate it in daily practice with more confidence.