PURPOSE: Training for advanced diagnostic and therapeutic bronchoscopic procedures is acquired during Interventional Pulmonology (IP) Fellowship. Unfortunately number of such programs is small limiting dissemination of formal training. The aim is to study success of conventional TBNA (C-TBNA) in the hands of bronchoscopists without formal IP training ; which is a usual scenario in third-world countries and where EBUS equipment are difficult to obtain.
METHODS: Knowledge of C-TBNA was solely gathered from literature, videos and practicing on inanimate models at "Hands-On" courses. C-TBNA was performed consecutively in patients with undiagnosed mediastinal lymphadenopathy (MLA), either using cytology or histology needles or both.
RESULTS: 28 patients (M:F=18:10) with mean age of 54.7±12.0 years underwent C-TBNA using either 21g or19g (or both) SmoothShot Olympus(r) needles for MLA. 18 patients had lymph nodes larger than 20 mms and the remainder between 10- 20 mm. Location of the target lymph nodes were 12 right paratracheal, 9 subcarinal, 5 right hilar, 2 left hilar regions. Suspected diagnoses were: lung cancer(14), tuberculosis (TB)8, sarcoidosis (5) and lymphoma(1). Final diagnoses were: lung cancer(11), Sarcoidosis (3), TB and lymphoma, one of each and reactive lymph nodes(12). Final diagnosis was established by C-TBNA in 11, by mediastinoscopy in 9, by transthoracic needle aspiration in 3, by extra-pulmonary biopsies in 3 and by bronchial mucosal biopsy in 2 patients. Sensitivity and the specificity of C-TBNA was 57.1% and 100%, respectively. The PPV was 100% and the NPV was 68.4%. The diagnostic efficacy of the procedure was 77.7%; these results are comparable to published data. We encountered neither complications nor damage to the bronchoscope.
CONCLUSION: C-TBNA can be learned by reading books and practicing on inanimate models and results similar to the published data are achieved.
CLINICAL IMPLICATIONS: TBNA allows to diagnose and stage pulmonary and mediastinal lesions in a minimally invasive fashion, even in absence of endobronchial disease. Despite such advantages, TBNA is underutilized; the trend which may change since trainees are increasingly gaining experience with the technique.
DISCLOSURE: Elif Kupeli, No Financial Disclosure Information; No Product/Research Disclosure Information