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Cost effectiveness of transbronchial needle aspiration: DISCUSSION (1)

TBNA

TBNA is an established procedure for the diagnosis and staging of lung cancer. The procedure is safe with few complications documented in the literature . This is comparable with a complication rate for cervical mediastinoscopy of 2.5% . The literature reports varied diagnostic yields of TBNA in patients with bronchogenic carcinoma. In 1983, Wang et al reported a yield of 49% in patients with known or suspected bronchogenic carcinoma; all of the patients had a radiographically abnormal mediastinum. In 1994, Wang et al published another paper on a series of patients with pulmonary nodules or masses and/or mediastinal or hilar lesions with a diagnostic yield for TBNA of 89.3%. Shure and Fedullo reported on a series of 110 patients with suspected bronchogenic carcinoma (identified by an abnormal chest radiograph, symptoms or an endoscopic abnormality). Patients underwent transcarinal needle aspiration with a yield of 14.5%. Schenk et al studied a group of 88 patients with suspected bronchogenic carcinoma, 44 of whom had significant mediastinal adenopathy on CT scan. Seventeen of the 44 patients had a positive TBNA with a yield of 39%. Utz et al reported a series of 88 patients with bronchogenic cancer with an overall yield of 36% for subcarinal TBNA and a yield of 43% in patients with radiographic evidence of subcarinal adenopathy.

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