Am. J. Respir. Crit. Care Med.,
Volume 157, Number 6, June 1998, 1913-1918
Transbronchial Needle Aspiration (TBNA) in Patients
Infected with HIV
TIMOTHY J.
HARKIN,
CARLO
CIOTOLI,
DOREEN J.
ADDRIZZO-HARRIS,
DAVID P.
NAIDICH,
JAISHREE
JAGIRDAR,
and
WILLIAM N.
ROM
Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University Medical Center,
Chest Service, Bellevue Hospital Center, New York, New York
Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes has been shown to be useful
in the diagnosis and staging of bronchogenic carcinoma. With the exception of sarcoidosis, the usefulness of TBNA has not been widely investigated in other clinical settings. We investigated the utility
of TBNA with a 19-gauge histology needle in HIV-infected patients with mediastinal and hilar adenopathy at Bellevue Hospital Center. We performed 44 procedures in 41 patients. Adequate lymph
node sampling was obtained in 35 of 44 (80%), and diagnostic material was obtained in 23 of 44 (52%) procedures. TBNA was the exclusive means of diagnosis in 13 of 41 (32%) patients. Of the 44 procedures, 23 (52%) were performed in patients with mycobacterial disease, with TBNA providing
the diagnosis in 20 of 23 (87%). In these patients, positive TBNA specimens included smears of aspirated materials for acid-fast bacilli in 11, mycobacterial culture in 14, and histology in 15. In other diseases, TBNA diagnosed sarcoidosis with noncaseating granulomata in 2 of 4 patients and non-small cell lung cancer in 1 of 2 patients. TBNA was not helpful in other diseases including Pneumocystis carinii pneumonia, infection with Cryptococcus or Nocardia, bacterial pneumonia, viral pneumonia, and
Kaposi's sarcoma. No pulmonary diagnosis was established in five patients. No complications of
TBNA occurred. We conclude that TBNA through the flexible bronchoscope is safe and effective in
the diagnosis of intrathoracic adenopathy in HIV-infected patients, and is particularly efficacious in
the diagnosis of mycobacterial disease. Furthermore, TBNA may provide the only diagnostic specimen in almost one-third of HIV-infected patients, thereby sparing these patients more invasive procedures such as mediastinoscopy.
