Objective: To demonstrate the usefulness of real-time
guidance with CT fluoroscopy to improve the yield of transbronchial
needle aspiration (TBNA).
Setting: A tertiary-care,
university-affiliated medical center.
December 1998 to April 2000, 35 patients underwent CT
fluoroscopy-guided TBNA. Patients with subcarinal and precarinal lymph
nodes were only included if a previous attempt was nondiagnostic, as
the initial yield in this setting with conventional TBNA is high. TBNA
was performed using standard technique in a CT-scan suite. Needle
location was confirmed with fluoroscopy without IV contrast being used.
Specimens were evaluated on-site for adequacy.
Results: The procedure had to be aborted in three patients
before TBNA could be performed. Samples were obtained in 32 patients.
Samples were nondiagnostic in four patients. Adequate tissue was
obtained in 28 of 32 patients (87.5%). Twenty-two patients had a
specific benign or malignant diagnosis made, and 6 patients had
lymphocytes only on the specimen. In follow-up, only one of these six
patients proved to have a malignancy. All procedures were performed
within a regular interventional CT time slot of 1 h. No TBNA side
effects were noted.
Conclusion: TBNA under CT
fluoroscopic guidance is easy to perform. The yield in all accessible
lymph node stations is high.