This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chin, R. Articles by Haponik, E. F. Search for Related Content PubMed PubMed Citation Articles by Chin, R., Jr. Articles by Haponik, E. F.

Transbronchial Needle Aspiration in Diagnosing and Staging Lung Cancer

How Many Aspirates Are Needed?

Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Department of Pathology, Department of Radiology, and Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Reno, Reno, Nevada; and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland

Correspondence and requests for reprints should be addressed to Robert Chin, Jr., M.D., Wake Forest University Baptist Medical Center, Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1054. E-mail: Rchin{at}wfubmc.edu

Transbronchial needle aspiration has emerged as a key technique for sampling mediastinal adenopathy but variable yields are reported. To determine the number of aspirates needed to optimize yield, we prospectively studied transbronchial needle aspiration and the sequential effect of each successive specimen on diagnostic yield in 79 patients with known or suspected lung carcinoma and mediastinal adenopathy. A total of 451 aspirates were performed in 79 patients (mean, 5.7 aspirates per patient; range, 2–13) with 45 cases (57%) positive for malignancy. A cytologically positive transbronchial needle aspiration occurred with the first aspirate in 42% of patients in whom this procedure established mediastinal nodal involvement. All positive results were achieved with seven or fewer aspirates. Similar yields were obtained for small cell and non-small cell lung cancer after seven aspirates. Rapid on-site specimen cytologic evaluation was used in 55 of 79 cases (70%), with a positive diagnosis obtained in 39 of 55 cases (71%) with on-site evaluation compared with six of 24 cases (25%) performed without on-site evaluation. The data suggest there is a plateau in yield after seven transbronchial needle aspirates, which may be sufficient to obtain an optimal yield in assessing patients with lung cancer and mediastinal adenopathy.

Key Words: biopsy, needle • bronchoscopy • cytodiagnosis • lung neoplasms • neoplasm staging

This article has been cited by other articles:

				A. Tremblay, D. R. Stather, P. MacEachern, M. Khalil, and S. K. Field A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis Chest, August 1, 2009; 136(2): 340 - 346. [Abstract] [Full Text] [PDF]

				G. M. Weiner, K. Schulze, B. Geiger, H. Ebhardt, K.-J. Wolf, and T. Albrecht CT Bronchoscopic Simulation for Guiding Transbronchial Needle Aspiration of Extramural Mediastinal and Hilar Lesions: Initial Clinical Results Radiology, March 1, 2009; 250(3): 923 - 931. [Abstract] [Full Text] [PDF]

				D. Ost, R. Shah, E. Anasco, L. Lusardi, J. Doyle, C. Austin, and A. Fein A Randomized Trial of CT Fluoroscopic-Guided Bronchoscopy vs Conventional Bronchoscopy in Patients With Suspected Lung Cancer Chest, September 1, 2008; 134(3): 507 - 513. [Abstract] [Full Text] [PDF]

				H. S. Lee, G. K. Lee, H.-S. Lee, M. S. Kim, J. M. Lee, H. Y. Kim, B.-H. Nam, J. I. Zo, and B. Hwangbo Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Staging of Non-Small Cell Lung Cancer: How Many Aspirations Per Target Lymph Node Station? Chest, August 1, 2008; 134(2): 368 - 374. [Abstract] [Full Text] [PDF]

				N. Navani, S. M. Janes, and S. G. Spiro Lung Cancer Staging With Minimally Invasive Endoscopic Techniques JAMA, June 4, 2008; 299(21): 2509 - 2509. [Full Text] [PDF]

				M. B. Wallace Lung Cancer Staging With Minimally Invasive Endoscopic Techniques--Reply JAMA, June 4, 2008; 299(21): 2510 - 2511. [Full Text] [PDF]

				R. Trisolini, C. Tinelli, A. Cancellieri, D. Paioli, M. Alifano, M. Boaron, and M. Patelli Transbronchial needle aspiration in sarcoidosis: Yield and predictors of a positive aspirate. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 837 - 842. [Abstract] [Full Text] [PDF]

				M. B. Wallace, J. M. S. Pascual, M. Raimondo, T. A. Woodward, B. L. McComb, J. E. Crook, M. M. Johnson, M. A. Al-Haddad, S. A. Gross, S. Pungpapong, et al. Minimally Invasive Endoscopic Staging of Suspected Lung Cancer JAMA, February 6, 2008; 299(5): 540 - 546. [Abstract] [Full Text] [PDF]

				A. H. Diacon, M. M. Schuurmans, J. Theron, K. Brundyn, M. Louw, C. A. Wright, and C. T. Bolliger Transbronchial needle aspirates: how many passes per target site? Eur. Respir. J., January 1, 2007; 29(1): 112 - 116. [Abstract] [Full Text] [PDF]

				F. J. F. Herth, K. F. Rabe, S. Gasparini, and J. T. Annema Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions Eur. Respir. J., December 1, 2006; 28(6): 1264 - 1275. [Abstract] [Full Text] [PDF]

				G. Plat, P. Pierard, A. Haller, J. Hutsebaut, J. Faber, M. Dusart, P. Eisendrath, J-P. Sculier, and V. Ninane Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes Eur. Respir. J., February 1, 2006; 27(2): 276 - 281. [Abstract] [Full Text] [PDF]

				S Gasparini and G A Silvestri Usefulness of transbronchial needle aspiration in evaluating patients with lung cancer Thorax, November 1, 2005; 60(11): 890 - 891. [Full Text] [PDF]

				K. G. Tournoy, M. M. Praet, G. Van Maele, and J. P. Van Meerbeeck Esophageal Endoscopic Ultrasound With Fine-Needle Aspiration With an On-site Cytopathologist: High Accuracy for the Diagnosis of Mediastinal Lymphadenopathy Chest, October 1, 2005; 128(4): 3004 - 3009. [Abstract] [Full Text] [PDF]

				K. Kanoh, T. Miyazawa, N. Kurimoto, Y. Iwamoto, Y. Miyazu, and N. Kohno Endobronchial Ultrasonography Guidance for Transbronchial Needle Aspiration Using a Double-Channel Bronchoscope Chest, July 1, 2005; 128(1): 388 - 393. [Abstract] [Full Text] [PDF]

				R. C. Rintoul, K. M. Skwarski, J. T. Murchison, W. A. Wallace, W. S. Walker, and I. D. Penman Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging Eur. Respir. J., March 1, 2005; 25(3): 416 - 421. [Abstract] [Full Text] [PDF]

				F. Herth, H. D. Becker, and A. Ernst Conventional vs Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Trial Chest, January 1, 2004; 125(1): 322 - 325. [Abstract] [Full Text] [PDF]

				G. A. Silvestri, B. Hoffman, and C. E. Reed One From Column A: Choosing Between CT, Positron Emission Tomography, Endoscopic Ultrasound With Fine-Needle Aspiration, Transbronchial Needle Aspiration, Thoracoscopy, Mediastinoscopy, and Mediastinotomy for Staging Lung Cancer Chest, February 1, 2003; 123(2): 333 - 335. [Full Text] [PDF]

				M. J. Tobin Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2002 Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 356 - 370. [Full Text] [PDF]