Abstract
Background
Lung cancer is the leading cause of cancer deaths around the world. Globally, lung cancer is the largest contributor to new cancer diagnosis and to death from cancer. Various conventional diagnostic techniques (CDTs) such as endobronchial forcep biopsy (FB), bronchial washing (BW) and bronchial brushing (BB), and transbronchial needle aspiration cytology (TBNA) are employed during fiber-optic bronchoscopy.
Methods
This is a prospective study conducted between June 2012 and September 2013 at Bronchoscopy unit of MIMSR Medical College Latur, India, to find the role of TBNA in exophytic endobronchial lesions in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BB, BW and FB, and included 150 patients on the basis of clinical and radiological features of malignancy. In exophytic endobronchial lesions, predominant endoscopic findings were cauliflower, polypoidal-like or nodular or multinodular endobronchial growth. TBNA, FB, BB and BW were performed in all the cases during FOB. Histopathological and cytological examinations of specimens were performed at Pathology department. The statistical analysis was done using chi-square test.
Results
Total 150 patients, between age group 24–80 years, mean age was 57.93 years, male population constitutes 86.17 % of total. 76.14 % cases were smoker of them 61.87 % cases having history of >40 pack years. Commoner symptoms were cough (91.33 %), hemoptysis (54.00 %) and chest pain (46.66 %), and mass lesion (40.66 %), hilar opacity (31.33 %) and collapse segmental/lobar (29.33 %) were commoner radiological abnormalities. Yield of TBNA, CDT and TBNA plus CDT in exophytic lesions is 60.66, 79.33 and 84.66 %, respectively, in diagnosis of lung malignancies (P < 0.001). Sensitivity of forcep biopsy and TBNA in diagnosing lung malignancy was 88.18 and 71.65 %, respectively (P < 0.01). FOB-related hypoxemia documented in two cases and minor bleeding in six cases. Other complications such as significant bleeding, pneumothorax and death were not seen. Minor bleeding was seen with forcep biopsy mainly in 4.0 % cases. TBNA has decreased repeat procedure, decreases cost for diagnosis. IHC on TBNA specimens had increased histological-type confirmation.
Conclusion
Transbronchial needle aspiration is a beneficial, safe and minimally invasive bronchoscopic technique with insignificant side effect in the diagnosis bronchogenic carcinoma. TBNA considered safe, especially when fleshy vascular endobronchial growth is present and risk of bleeding is high with forcep biopsy. Inadequate tissue sampling due to the presence of necrosis, blood clot over the lesion and formation of crush artifacts by FB makes TBNA valuable in these lesions. TBNA will definitely decrease need for repeat bronchoscopy.
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References
Bilaceroglu S, Gunel O, Cagirici U, Perim K (1997) Comparison of endobronchial needle aspiration with forcep and brush biopsies in the diagnosis of endobronchial cancer. Monaldi Arch Chest Dis 52:13–17
Bollinger CT, Plekker D, Koegelenberg CFN (2010) Different techniques in bronchoscopy. Eur Respir Mon 45:1–17
Caglayan B, Akturk UA, Fidan A, Salepci B et al (2005) Transbronchial needle aspiration in the diagnosis of endobronchial malignant lesions. Chest 128(2):704–708
Choudhry MK, Rasul S, Iqbal ZH, Qureshi SS, ul-Haq M, Hussain G, Akhtar AM (1999) Fiberoptic bronchoscopy: Role in the diagnosis of bronchogenic carcinoma. Biomedica 1999(14):32–36
Dasgupta A, Minai OA, Mehta AC (2000) Transbronchial needle aspiration of central and peripheral lesions. In: Bollinger CT, Mathur PN (eds) Interventional bronchoscopy. Karger, Basel, pp 66–70
Diacon A, Schuurmans M, Bollinger CT (2005) Utility of rapid on site evaluation of transbronchial needle aspirates. Respiration 72:182–188
Gao L, Yang T, Chen T et al (2012) Descriptive data on cancerous lung lesions detected by autofluorescence bronchoscope: a five year study. Ann Thorac Med 7(1):21–25
Gellert AR, Rudd RM, Sinha G, Geddes DM (1982) Fiberoptic bronchoscopy: effect of experience of operator on diagnostic yield of bronchial biopsy in bronchial carcinoma. Br J Dis Chest 76:397–399
Govert JA, Dodd LG, Kussin PS, Samuelson WM (1999) A prospective comparison of fiberoptic transbronchial needle aspiration and bronchial biopsy for bronchoscopically visible lung carcinoma. Cancer 87(3):129–134
Haponick EF, Cappelari JO, Chin R, Alford PT, Bowton DL (1995) Education and experience improves transbronchial needle aspiration performance. Am J Respir Crit Care Med 151:1998–2002
Harras A, Page H (1996) The cancer statistics branch. In: Cancer rates and risks, 4th edn. National Institutes of Health, Bethesda
Joos L, Patuto N, Chhajed PN, Tamm M et al (2006) Diagnostic yield of flexible bronchoscopy in current clinical practice. Swiss Med Wkly 136:155–159
Jin F, Mu D, Chu D et al (2008) Severe complications of bronchoscopy. Respiration 76:429–433
Lachman MF, Schofield K, Cellura K (1999) Bronchoscopic diagnosis of malignancy in the lower airway: a cytologic review. Acta Cytol 39:1148–1151
Mazzone P, Jain P, Arroliga AC, Matthay RA (2002) Bronchoscopy and needle aspiration techniques for diagnosis and staging of lung cancer. Clin Chest Med 23:137–158
Roth K, Hardie JA, Andreassen AH, Leh F, Eagan TM et al (2008) Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques. BMC Pulm Med 26(8):2
Shure D, Feddulo PF (1985) Transbronchial needle aspiration in diagnosis of submucosal and peribronchial bronchogenic carcinoma. Chest 88:49–51
Siegel R, Ward E, Brawley O, Cancer statistics et al (2011) The impact eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J clin 61(4):212–236
Time Trends in Cancer Incidence Rates 1982–2005, published by the National Cancer Registry Programme (ICMR), Bangalore
Wang KP, Brower R, Haponik EF, Siegelman S (1983) Flexible transbronchial needle aspiration for staging of bronchogenic carcinoma. Chest 84(5):571–576
British Thoracic Society guidelines for advanced diagnostic and therapeutic flexible bronchoscopy in adults (2011). Thorax 66(3)
Ernst A, Silvestri GA, Johnstone D (2003) Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest 123:1693–1717
Gullon JA, Fernandez R, Medina A et al (2003) Transbronchial needle aspiration in bronchogenic carcinoma with visible lesions: diagnostic yield and cost. Arch Bronconeumol 39:496–500
Karahalli E, Yilmaz A, Türker H, Ozvaran K et al (2001) Usefulness of various diagnostic techniques during fiberoptic bronchoscopy for endoscopically visible tumours. Respiration 68(6):611–614
Salathe M, Soler M, Bolliger CT et al (1992) Transbronchial needle aspiration in routine fiberoptic bronchoscopy. Respiration 59:5–8
Siddiqui MT, Saboorian MH, Gokaslan ST et al (2001) The utility of transbronchial (Wang) fine needle aspiration in lung cancer diagnosis. Cytopathology 12:7–1482
Verma SK, Shrivastav AN, Prasad R (2011) Study of fiberoptic bronchoscope in endoscopically visible bronchial carcinoma. Int Infect Dis 1:7
(2005) Effectiveness of transbronchial needle aspiration in the diagnosis of exophytic endobronchial lesions and submucosal/peribronchial diseases of the lung. Lung Cancer 50(2):221–622. Epub 19 Jul 2005
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Shital, P., Rujuta, A. & Sanjay, M. Transbronchial needle aspiration cytology (TBNA) in endobronchial lesions: a valuable technique during bronchoscopy in diagnosing lung cancer and it will decrease repeat bronchoscopy. J Cancer Res Clin Oncol 140, 809–815 (2014). https://doi.org/10.1007/s00432-014-1602-x
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DOI: https://doi.org/10.1007/s00432-014-1602-x