Chest
Volume 84, Issue 5, November 1983, Pages 571-576
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Flexible Transbronchial Needle Aspiration for Staging of Bronchogenic Carcinoma

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Flexible transbronchial needle aspiration (TBNA) provides access to mediastinal lymph nodes, but its role in staging bronchogenic carcinoma is unknown. To determine the efficacy and safety of this procedure for staging the extent of mediastinal disease, the results of TBNA performed during fiberoptic bronchoscopy in 39 patients without known extrathoracic metastases were reviewed. Flexible TBNA was found to be a safe, effective method for determining the presence or absence of mediastinal metastases from bronchogenic carcinoma. Furthermore, TBNA results compare favorably with roentgenographic staging techniques, with the added advantage of providing cytopathologic information.

Section snippets

Patient Population

Patients with known or suspected bronchogenic carcinoma who were referred to the bronchoscopy service of the Johns Hopkins Hospital between Nov 1, 1981, and Nov 17, 1982, were included in this study if a staging procedure was indicated at the time of bronchoscopy. In 28 patients with undiagnosed pulmonary lesions, bronchoscopy was performed primarily for diagnostic purposes. In the remaining 11 patients, bronchoscopy was performed solely for staging. Patients with known small cell carcinoma,

Results

Thirty-nine patients met criteria for inclusion in the study. Bronchoscopy and TBNA were repeated in one patient with an initial equivocal TBNA specimen for a total of 40 procedures. The histologic classifications and the primary anatomic locations of their neoplasms are summarized in Table 1. The diagnosis of carcinoid tumor was not made until thoracotomy in two patients, who are included in this series because they underwent preoperative staging with a presumptive diagnosis of bronchogenic

Discussion

These data indicate that staging of bronchogenic carcinoma to define mediastinal nodal involvement (N status), as well as the extent of endobronchial disease (T status), can now be combined effectively with diagnostic fiberoptic bronchoscopy (Fig 1). Furthermore, this objective can be achieved both safely and accurately. The diagnostic efficacy of TBNA compared favorably with that of roentgenographic staging methods, with the added advantages provided by cytopathologic information. In many of

ACKNOWLEDGMENT

We writers thank Betty Giacomazza and Lorena Clary for secretarial assistance and Pam Mason and Jennifer Grago for providing the illustrations.

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    Manuscript received February 28; revision accepted May 2.

    Reprint requests: Dr. Wang, Respiratory Division, Brady 4, The Johns Hopkins Hospital, Baltimore 21205

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