Transbronchial needle aspiration for histology specimens

Our plain-English summary of Transbronchial needle aspiration for histology specimens, by A.C. Mehta, M.S. Kavuru, D.P. Meeker, et al (Chest, 1989).

The study

• Authors: A.C. Mehta, M.S. Kavuru, D.P. Meeker, G.N. Gephardt, C. Nunez
• Journal: Chest
• Published: 1989;96(6):1228-32
• Type of article: Case report
• Cited by: 91 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Fine-gauge (22-G) transbronchial needle aspiration (TBNA) has significantly added to the diagnostic yield of FOB, and in some institutions has become routine in staging bronchogenic carcinoma. Cytologic examination of the specimen obtained by n228G TBNA, however, has several limitations. The mediastinal aspirate can be contaminated by tumor cells from respiratory secretions, giving false positive diagnoses of unresectability. The diagnosis of benign conditions can seldom be made. Using 18-G TBNA, we can obtain specimens for histologic examination from paratracheal, peribronchial, and carinal areas by FOB. Both 18-G and 22-G TBNA were performed in 34 patients with radiographic abnormalities involving mediastinal or hilar areas. Tissue for histologic examination was obtained in 17 patients (50 percent) using 18-G TBNA and was diagnostic in 11 (32 percent), including three patients with benign conditions. The overall diagnostic yeild of 18-G TBNA was 41 percent (14/34 patients), increasing the yield of FOB from 50 percent to 58 percent. There were no false positive results and few minor complications. 18-G TBNA is effective in obtaining tissue for histologic examination and diagnosing benign conditions. In selected cases this technique increases the diagnostic yield of FOB.

In plain English

This article does not study asbestos. It reported the Cleveland Clinic's experience with a wider 18-gauge needle, passed through a flexible bronchoscope, to take tissue samples from lymph-node areas in the chest. It was compared with the usual fine 22-gauge needle, which yields only loose cells. Both needles were used in 34 patients with radiographic abnormalities in the mediastinal or hilar areas. Usable tissue was obtained in 17 patients. The 18-gauge needle gave a diagnosis in 41 percent of patients: 32 percent from tissue and 9 percent from cell samples. This raised the overall diagnostic yield of bronchoscopy from 50 percent to 58 percent, with no false positive results. In five patients the needle could not be inserted. Three patients had bleeding, reported as less than 50 ml but with a maximum of 50 ml in one patient. In one patient the sample showed a benign lymph node; the patient was later found to have pleural mesothelioma without mediastinal involvement. The authors concluded that the 18-gauge needle was effective in obtaining tissue and diagnosing benign conditions. They called their experience preliminary.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: single-institution clinical case series describing experience with a bronchoscopic needle technique
• Who was studied: 34 patients at the Cleveland Clinic with radiographic abnormalities involving the mediastinal or hilar areas; study dates not given
• Exposure: No asbestos exposure was studied. The study evaluated an 18-gauge transbronchial needle for tissue (histology) specimens and compared it with the 22-gauge needle used for cytology.
• Main results:
  • Adequate specimens for tissue examination were obtained in 17 of the 34 patients
  • Overall diagnostic yield of the 18-gauge needle was 41 percent: 32 percent by tissue examination and 9 percent by cell examination
  • The 18-gauge needle increased the diagnostic yield of bronchoscopy from 50 percent to 58 percent, with no false positive results
  • When 22-gauge aspiration was positive, the 18-gauge specimen was always positive (provided two successful 18-gauge passes were made)
  • Three patients had bleeding, described as less than 50 ml
  • The article also reported maximum bleeding of 50 ml in one patient with mitral valve disease, congestive heart failure and pleural effusion, which does not match the 'less than 50 ml' wording
  • One patient whose 18-gauge specimen showed a benign lymph node segment was later found to have pleural mesothelioma without mediastinal involvement
• The authors' conclusion: The authors concluded that 18-gauge transbronchial needle aspiration is effective in obtaining tissue for histologic examination and diagnosing benign conditions, and in selected cases increases the diagnostic yield of bronchoscopy.
• Limitations the authors state:
  • The authors described the results as preliminary experience
  • A newer Olympus bronchoscope model could not accept the 18-gauge needle through its channel

Topics

Medical terms in this study, explained in our Lexicon: Histology, Staging, Bronchogenic Carcinoma, Aspirate.

Related studies

• Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle — R. Trisolini, F. Natali, et al. (2018)
• Electron microscopy in the diagnosis of percutaneous fine needle aspiration specimens — E.J. Wills, S. Carr, et al. (1987)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• Pulmonary needle aspiration biopsy in the diagnosis of Pancoast tumors — W.J. Walls, J.R. Thornbury, et al. (1974)
• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)

Browse more research in Chest, or return to medical research.