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Vol. 13. Issue 5.
Pages 651-658 (September - October 2007)
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Vol. 13. Issue 5.
Pages 651-658 (September - October 2007)
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Transbronchial needle aspiration of hilar and mediastinal lymph nodes
Punção aspirativa transbrônquica por agulha de linfonodos hilares e mediastinais
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Deborah Lannes1, Andréia Salarini Monteiro1, Edson Toscano2, Aureliano Cavalcanti3, Marilene Nascimento4, Paulo de Biasi5, Mauro Zamboni6,
1 Pneumologista do Grupo de Oncologia Torácica – Hospital do Câncer – HC I – INCA/MS / Pulmonologist, Thoracic Oncology Group - Hospital do Câncer – HC I – INCA/MS
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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Article information
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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Copyright © 2007. Sociedade Portuguesa de Pneumologia
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