Transbronchial needle aspiration of hilar and mediastinal lymph nodes

Lannes, Deborah; Salarini Monteiro, Andréia; Toscano, Edson; Cavalcanti, Aureliano; Nascimento, Marilene; de Biasi, Paulo; Zamboni, Mauro

doi:10.1016/S2173-5115(07)70360-3

Pulmonology

ISSN: 2531-0437

Pulmonology (previously Revista Portuguesa de Pneumologia) is the official journal of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia/SPP). The journal publishes 6 issues per year, mainly about respiratory system diseases in adults and clinical research. This work can range from peer-reviewed original articles to review articles, editorials, and opinion articles. The journal is printed in English, and is freely available in its web page as well as in Medline and other databases.

Special Issue 2023. Volume 29, Issue S4.

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2 Cirurgião de Tórax do Grupo de Oncologia Torácica – Hospital do Câncer – HC I – INCA/MS. Título de Especialista pela SBCT. Mestre em Cirurgia Torácica pela Universidade Federal Fluminense / Thoracic Surgeon, Thoracic Oncology Group – Hospital do Câncer – HC I – INCA/MS. Specialist, SBCT. MSc in Thoracic Surgery, Universidade Federal Fluminense

3 Cirurgião de Tórax do Grupo de Oncologia Torácica – Hospital do Câncer – HC I – INCA/MS. Título de Especialista pela SBCT / Thoracic Surgeon, Thoracic Oncology Group – Hospital do Câncer – HC I – INCA/MS. Specialist, SBCT

4 Patologista do Grupo de Oncologia Torácica – Hospital do Câncer – HC I – INCA/MS. Título de Especialista pela Sociedade Brasileira de Patologia / Pathologist, Thoracic Oncology Group – Hospital do Câncer HC I – INCA/MS. Specialist, Sociedade Brasileira de Patologia

5 Cirurgião de Tórax do Grupo de Oncologia Torácica – Hospital do Câncer – HC I – INCA/MS. Chefe do Serviço de Cirurgia Torácica do HC I – INCA/MS Título de Especialista pela SBCT. Doutor em Cirurgia Torácica pela Universidade Federal Fluminense / Thoracic Surgeon, Thoracic Oncology Group – Hospital do Câncer – HC I – INCA/MS. Director, Thoracic Surgery Unit, HC I – INCA/MS Specialist, SBCT. Thoracic Surgeon Universidade Federal Fluminense

6 Pneumologista do Grupo de Oncologia Torácica – Hospital do Câncer – HC I – INCA/MS Título de Especialista pela SBPT/AMB. Mestre em Pneumologia pela Universidade Federal Fluminense. Fellow American College of Chest Physicians / Pulmonologist, Thoracic Oncology Group – Hospital do Câncer – HC I – INCA/MS Specialist, SBPT/AMB. MSc in Pulmonology, Universidade Federal Fluminense. Fellow American College of Chest Physicians

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Abstract

Background

Besides clarifying the etiology of unidentified lymphadenomegaly, puncturing hilar and mediastinal lymph nodes by a flexible bronchoscopic needle is an aid in diagnosing and staging bronchogenic cancer or other metastatic cancers.

Objective

Our study had the principal objective to evaluate the positivity of transbronchial needle aspiration (TBNA).

Method

We evaluated retrospectively the effectiveness of all TBNA done in 74 consecutive patients. Forty-nine patients were male and the median age was 59. We used Wang-needles, 21-gauge (Bard, USA), and the same technique described for differents authors. Of the 74 patients evaluated, 11(15%) showed mediastinal mass and 65 (85%) hilar mass. We observed 76 endoscopics abnormalities.

Results

According to the classification of the specimens, we had 32/74 (43%) unsatisfactory specimens, 34/74 (46%) satisfactory and diagnostic specimens, and 8/74(11%) satisfactory and non-diagnostic specimens. Thirty four (46%) of the examinations were found to be positive out of the total amount of specimens. Of the positive results, 30/34 specimens (88%) contained malignant disease. Small-cell carcinoma was the most frequent finding, with 10/34 cases (29%); squamous cell carcinoma 7/34 (21%); adenocarcinoma 7/34 (21%), non--small cell carcinoma 6/34 (17%); sarcoidosis 2/34 (6%) and tuberculosis 2/34 (6%).

Conclusion

Our study indicated that this method is safe, easy to perform, with a minimum of complications and useful for the diagnosis and staging of pulmonary neoplasms.

Key-words:

Lung cancer

cytology

staging

flexible bronchoscopy

lymph node metastases

transbronchial needle aspiration

Resumo

Introdução

A punção com agulha através da broncofibroscopia (TBNA), além de ser útil no esclarecimento das linfodenomegalias hilares e mediastinais, é também de utilidade no diagnóstico e estadiamento do carcinoma brônquico e de outras neoplasias metastáticas.

Objectivo

Avaliar restrospectivamente a eficácia das TBNA realizadas em 74 doentes consecutivos. Quarenta e nove deles do sexo masculino e com idade mediana de 49 anos. Utilizámos a agulha de Wang, 21--gauge (Bard, USA), e a técnica utilizada foi a descrita pelos diversos autores. Dos 74 doentes estudados, 11 (15%) tinham linfadenomegalia mediastinal e 65 (85%) hilar. Observámos 72 anormalidades endoscópicas.

Resultados

De acordo com a classificação do material obtido, tivemos 32/74 (43%) cujo material foi insatisfatório para o diagnóstico; em 34/74 (46%), o material foi satisfatório e capaz de definir o diagnóstico; e 8/74 (11%) nos quais o material obtido foi satisfatório mas insuficiente para se definir o diagnóstico. Da amostra, 34 (46%) foram positivos. Destes, 30/34 (88%) eram doenças malignas. O carcinoma indiferenciado de pequenas células foi o mais comummente encontrado, com 10/34 (29%); o carcinoma escamoso, 7/34 (21%); o adenocarcinoma, 7/34 (21%); e o carcinoma de não pequenas células, 6/34 (17%). A sarcoidose foi identificada em 2/34 (6%) e a tuberculose em 2/34 (6%).

Conclusão

O método é seguro, de fácil realização, com pequeno índice de complicações e de utilidade para o diagnóstico e estadiamento do cancro do pulmão.

Palavras-chave:

Carcinoma brônquico

citologia

estadiamento

broncofibroscopia

metástases linfonodais

punção aspirativa transbrônquica com agulha

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