Transbronchial needle aspiration in the practice of bronchoscopy

We reviewed the records of all patients who underwent bronchoscopy with a flexible fiberoptic instrument and transbronchial needle aspiration (TBNA) at our institution between August 1983 and December 1985. During 85 bronchoscopy sessions, 89 TBNAs were performed in 84 patients. Seventy-three aspirates were obtained from 68 patients who were eventually proved to have a malignant lesion. Of these 68 patients, 25 had positive results of TBNA (37%). Of these 25 patients, 15 had non-small-cell cancers (11 bronchogenic and 4 metastatic from extrapulmonary sites), and 10 had small-cell carcinomas. In patients with a malignant lesion, 23% of the central aspirates (from paratracheal regions or within 2 cm of the carina) and 65% of the distal aspirates (beyond 2 cm from the carina) were positive (a total yield of 34%). Five of the distal aspirates were obtained from peripheral lesions under fluoroscopic guidance, and three were positive for a malignant process. In eight patients, the only malignant finding at bronchoscopy was the aspirate. Two of the eight patients had carcinoma metastatic to the lung, three had small-cell carcinoma, and the other three had bronchogenic carcinoma. In five patients, TBNA obviated more invasive diagnostic measures. We find TBNA to be useful in selected patients. It increases our diagnostic yield for small-cell carcinoma and carcinoma metastatic to the chest. TBNA should be considered when a submucosal process is present, extrinsic compression is evident, or an accessible extrabronchial mass is found radiographically.