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Transbronchial needle aspiration

Authors
Omar A Minai, MD
Atul C Mehta, MBBS, FCCP
Section Editor
Praveen N Mathur, MB, BS
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Transbronchial needle aspiration (TBNA) of mediastinal lymph nodes was initially described in 1949 and its application via flexible bronchoscopy was later described in 1981 [1-6]. Since then, its utility in the diagnosis of endobronchial, peripheral, and mediastinal lesions has been reported in research publications and confirmed with widespread clinical experience [7-14].

TBNA provides an opportunity to diagnose and stage pulmonary and mediastinal lesions (particularly lung cancer) in a minimally invasive fashion, even in the absence of endobronchial disease [15-17]. Despite such advantages, TBNA is underutilized [18,19], a trend that may change since trainees are increasingly gaining experience with the technique [20,21].

The role of TBNA in the diagnosis of mediastinal, central and peripheral lesions is reviewed here. In addition, anatomic and technical considerations are discussed. The staging of non-small cell lung cancer is presented separately. (See "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer" and "Tumor node metastasis (TNM) staging system for non-small cell lung cancer".)

DEFINITION

Transbronchial needle aspiration (TBNA) is the aspiration of material using a needle that is passed through the endobronchial wall. It is used to obtain cellular or core biopsy tissue from lung lesions that are accessible by bronchoscopy. Bronchoscopy is used to direct the operator to the target lesion (eg, lung mass or lymph node). The needle is then passed through the working channel of the bronchoscope, through the bronchial wall and material is aspirated for histological analysis. It can be performed as a blind procedure during conventional white light bronchoscopy (bronchoscopic-TBNA) or under image-guidance using a bronchoscope with endobronchial ultrasound or electromagnetic navigational capability (EBUS-TBNA; EMN-TBNA).

Details of the technique and the indications for bronchoscopy and EBUS are discussed separately. (See "Endobronchial ultrasound: Indications, contraindications, and complications", section on 'Indications' and "Flexible bronchoscopy in adults: Indications and contraindications", section on 'Indications' and 'Technique' below.)

                    

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 12 00:00:00 GMT+00:00 2016.
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