Transbronchial Needle Aspiration (TBNA) is a effective minimally invasive bronchoscopic method to sample lung masses and intrathoracic adenopathy. It’s use amongst pulmonologists are limited by perceptions of technical difficulties including device failure, complications of bleeding and bronchoscope damage. We report our initial experience with a new TBNA needle (eXcelon) designed to address the above issues.
Patients with lung masses and intrathoracic adenopathy referred for bronchoscopy are studied. Lesions (lymph nodes and masses) are sequentially sampled with the potentially higest staged lesion sampled first. Separate needles are used for distinct lesions. Type of needle (caliber), samples aspirated and prepared on slides are identified sequentially. Bedside cytopathologyis available for all cases. Adequacy of sample and preliminary diagnosis is given at time of TBNA. Complications and adverse events: TBNA catheter kinking, failure of locking or retraction, airway bleeding or mucosa trauma, and bronchoscope damage are recorded.
In this series of TBNA using the 21guage and 19guage eXcelon TBNA needles, yield of a positive diagnosis varies from 90% for primary lung cancer (100% for endobronchial tumor and 85% from lymph node and peripheral lung masses) to 87% adequate tissue sampling of benign lymph node or masses (sarcoid, aspergilloma and other granulomatous lesions). In the two to five month follow-up of non-malignant diseases, no new cancers were diagnosed. Complications include catheter kinking in 10%, dropped to 5% after use of the first ten needles. The eXcelon makes a larger entry hole, but there is no more than usual bleeding, and no pneumothoraces are noted. Overall ease of use is subjectively excellent because of design for single hand use of needle deployment and locking system.
The new 21G and 19G eXcelon TBNA are easy to use, has excellent safety profile and have yield comparable to presently available needles.
Improved end-user instrument compatibility and high yield may increase use of TBNA and improve diagnosis and staging of intrathoracic lesions.
R.C. Yung, Boston Scientific Microvasive