Transbronchial Needle Aspiration as a Diagnostic Method in Lung Cancer and Non-Malignant Mediastinal Adenopathy

Abstract

Introduction: The aim of the study was to assess the diagnostic yield of transbronchial needle aspiration (TBNA) in mediastinal or hilar adenopathy in: lung cancer, staging of NSCLC, sarcoidosis and other non-malignant diseases. Material and methods: Transbronchial needle aspiration was performed in 347 consecutive patients—402 biopsies in groups of lymph nodes: subcarinal (7)—179, all paratracheal (2R, 2L, 4R, 4L)—168 and hilar (10R, 10L)—55, with no real-time imaging guidance, preceded by computed tomography (CT), using 22-gauge needles. All negative results in NSCLC patients were verified by transcervical extended bilateral mediastinal lymphadenectomy (TEMLA) and the remaining patients underwent mediastinoscopy or thoracotomy. Results: TBNA technique was diagnostic in 67.1% of lung cancer patients and in 59.0% of patients with sarcoidosis. In the group of all lung cancer patients specificity was 100%, sensitivity 88.5%, accuracy 91.8% and negative predictive value 77.9% and in diagnosing of lymph nodes involvement in NSCLC was respectively 100%, 86.6%, 90.7% and 76.6%. The high diagnostic yield was comparable for all mediastinal groups. In 80% of NSCLC patients with false negative results of TBNA there was observed partial involvement of metastatic lymph nodes, confirmed by TEMLA. Conclusions: The diagnostic value of TBNA is very high in diagnostics of lung cancer, NSCLC staging and sarcoidosis but much lower in lymphomas, tuberculosis and other non-malignant diseases.