Blind transbronchial needle aspiration without an on-site cytopathologist: experience of 473 procedures

Transbronchial needle aspiration (TBNA) is an established procedure for sampling the mediastinal lymph nodes. Data reported from India are limited on this routine procedure. We describe our experience of the efficacy, diagnostic accuracy and safety of TBNA.

We retrospectively reviewed all TBNAs done at our centre between 2006 and 2009. Under local anaesthesia, accessible lymph node stations were sampled thrice without fluoroscopy and without an on-site cytopathologist. Data are presented in a descriptive manner.

A total of 4513 diagnostic bronchoscopies were done, of which 473 (10.5%) underwent TBNA. There were 297 men (63%) and 176 women (37%) with a mean (SD) age of 46.2 (13.98) years. The most common clinical diagnoses were sarcoidosis (50.5%), lung cancer (26.8%), tuberculosis (8.7%) and others (14%). The overall efficacy of TBNA in sampling a mediastinal/hilar lymph node was 72%. The accuracy of TBNA in achieving a pathological diagnosis was 40.4%, whereas the diagnostic yield of a successful procedure was 56.8% (lymph nodes were successfully sampled in 193 of 340 procedures). The most common diagnoses on cytology were sarcoidosis and lung cancer. In patients with a clinical diagnosis of lung cancer, the diagnostic accuracy of TBNA was 46.5% (59 of 127), whereas in patients with sarcoidosis it was 38.1% (91 of 239). TBNA provided an additional diagnostic yield in 5.6% (12 of 215) of patients with sarcoidosis who also underwent transbronchial lung biopsy. There were no periprocedural complications.

Blind TBNA is a safe and effective procedure that can be routinely done in the bronchoscopy suite.