PURPOSE: To enhance the yield of transbronchial needle aspiration (TBNA), advanced interventions like Endobronchial Ultrasound (EBUS) and CT fluoroscopic TBNA are utilized. However, these are not easily available in all countries and centers outside the USA. We conducted this analysis to evaluate the yield of NON-REAL TIME CT-guided TBNA transbronchial biopsy (TBB) sampling for mediastinal lymph nodes (LN) and peripheral lesions.
METHODS: CT guided TBNA (aspiration/biopsy) and TBB was performed on 18 patients on an OUTPATIENT basis. The radiologic indications included relatively small mediastinal nodes, difficult locations, or to enhance yield of procedure. After the screening CT (64-slice, Siemens Healthcare), bronchoscopy was performed with conventional TBNA/forceps insertion. As real-time CT fluoroscopy was not available, a rapid CT was done with the needle/forceps in location, to confirm placement in the lesion; this was confirmed by an attending radiologist. After CT confirmation, samples (Cytology/Histology/Forceps Biopsy) were obtained, with rapid on-site evaluation (ROSE). For TBNA, the sampling was done till ROSE results confirmed adequacy, with a maximum of 5 passes per location. For TBB, an average of 8 samples were taken.
RESULTS: There were 16 TBNA and 2 TBB done. TBNA: 23 locations were sampled, with an average LN size of 1.34cm (Range: 0.8-3 cm). TBB: 2 locations were sampled (average size: 2.95cm) 15/16 (93.75%) CT-TBNA patients had a positive diagnostic result (Tuberculosis: 7, Sarcoidosis: 6. Adenocarcinoma: 2), and 2/2 (100%) patients with CT-TBB tested positive (adenocarcinoma, squamous carcinoma). 1 TBNA was non-diagnostic. No significant complications were noted. All patients were discharged after 3 hours.
CONCLUSION: This is the first report to show non-REAL TIME CT-TBNA/TBB to be a high yield procedure (yield comparable to EBUS/CT fluoroscopy) for mediastinal LN/peripheral lesions. It is safe and can be done on an outpatient basis.
CLINICAL IMPLICATIONS: This study shows that non-REAL TIME CT-TBNA/TBB is a viable option to enhance yield, especially for smaller and difficult lesions, and can be a useful tool in countries and centers where EBUS/CT fluoroscopy is not available.
DISCLOSURE: Ravindra Mehta, No Financial Disclosure Information; No Product/Research Disclosure Information