CT scan directed transbronchial needle aspiration biopsy for mediastinal nodes

This study was performed to determine whether transbronchial needle aspiration (TBNA) biopsy under CT guidance can increase its diagnostic yield so that this technique can be used for staging of lung cancer at our institution.

After an initial unacceptable low yield of TBNA on the first 10 patients (20% positive), we switched the biopsy procedure from the bronchoscopy suite to the CT room. After each passage of the needle to the mediastinum lymph node, CT scan was performed to locate the tip of the needle. If the initial attempt was not successful, TBNA was repeated at the same setting until CT documented that the tip of the needle was exactly inside the lymph node.

A total of 49 patients with 69 mediastinum adenopathies were enrolled in this study. There were 31 patients with malignant mediastinal adenopathy proven by TBNA (60% sensitivity). Fifteen patients showed normal results of needle aspiration despite the presence of primary lung cancer. Three patients showed mediastinal abscesses.

Despite numerous successful reports in the literature, the general application of the TBNA procedure appears to be limited because of its low sensitivity, although this could be due to numerous factors. However, using CT guidance to be sure that the tip of the needle is exactly inside the node can increase its sensitivity markedly. It may also increase the specificity of normal results of TBNA biopsy.