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CT Fluoroscopy Guidance forTransbronchial Needle Aspiration

CT Fluoroscopy Guidance forTransbronchial Needle Aspiration...

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CT Fluoroscopy Guidance for Transbronchial Needle Aspiration* An Experience in 35 Patients Erik Garpestad, MD, FCCP; S. Nahum Goldberg, MD; Felix Herth, MD; Robert Garland, RRT; Joseph LoCicero III, MD, FCCP; Robert Thurer, MD, FCCP; and Armin Ernst, MD, FCCP Objective: To demonstrate the usefulness of real-time guidance with CT fluoroscopy to improve the yield of transbronchial needle aspiration (TBNA). Design: Prospective, observational. Setting: A tertiary-care, university-affiliated medical center. Methods: From December 1998 to April 2000, 35 patients underwent CT fluoroscopy-guided TBNA. Patients with subcarinal and precarinal lymph nodes were only included if a previous attempt was nondiagnostic, as the initial yield in this setting with conventional TBNA is high. TBNA was performed using standard technique in a CT-scan suite. Needle location was confirmed with fluoroscopy without IV contrast being used. Specimens were evaluated on-site for adequacy. Results: The procedure had to be aborted in three patients before TBNA could be performed. Samples were obtained in 32 patients. Samples were nondiagnostic in four patients. Adequate tissue was obtained in 28 of 32 patients (87.5%). Twenty-two patients had a specific benign or malignant diagnosis made, and 6 patients had lymphocytes only on the specimen. In follow-up, only one of these six patients proved to have a malignancy. All procedures were performed within a regular interventional CT time slot of 1 h. No TBNA side effects were noted. Conclusion: TBNA under CT fluoroscopic guidance is easy to perform. The yield in all accessible lymph node stations is high. (CHEST 2001; 119:329–332) Key words: bronchoscopy; CT fluoroscopy; mediastinal lymphadenopathy; transbronchial needle aspiration Abbreviations: LN 5 lymph node; TBNA 5 transbronchial needle aspiration T ransbronchial needle aspiration (TBNA) is useful in diagnosing mediastinal lymphadenopathy and staging lung cancer, 1 obviating the need for medias- tinoscopy in some patients. Despite these findings, TBNA remains an underutilized modality and has not been emphasized sufficiently in pulmonary and critical-care medicine training programs. 2 The lim- ited acceptance of this procedure appears to be in part due to the need for specific training in the procedure and a slow learning curve that can result in nondiagnostic biopsy attempts. This subsequently may lead to a belief that TBNA is not useful. 3 In contrast to ultrasound-guided GI needle biopsy, TBNA is a fairly “blind” procedure, with guidance generally limited to few endobronchial landmarks and mental reconstruction of a preprocedure CT of the chest. This precludes immediate control over the needle placement and does not allow for real-time feedback during the learning period. A previous study has shown that the yield of conventional CT scan-guided biopsies may be in- creased over regular attempts. In the study by Rong and Cui, 4 a very low baseline diagnostic yield of * From the Division of Pulmonary and Critical Care Medicine (Drs. Garpestad, Herth, and Ernst, and Mr. Garland), Division of
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  • Spring '11
  • HASSEL,PATRICIA
  • Biopsy, Needle aspiration biopsy, CT fluoroscopy, TBNA, transbronchial needle aspiration, CT fluoroscopy-guided TBNA

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