Skip to main content
The Egyptian Journal of Bronchology
Download PDF

Implementation of bronchoscopic conventional transbronchial needle aspiration service in a tertiary care chest hospital

Egyptian Journal of Bronchology volume 13, pages 309–313 (2019)Cite this article

Abstract

Background

Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allows the sampling tissue from beyond the endobronchial tree, such as enlarged lymph nodes, peribronchial, or submucosal lesions. However, it remains underutilized and even unavailable in many countries and centers around the world including Egypt.

Objective

This study aimed to implement bronchoscopic C-TBNA service in a tertiary care chest hospital with special emphasis on the diagnostic yield, complications encountered, and learning experience.

Patients and methods

This cohort study was conducted on 60 patients with bronchoscopic nonvisible extraluminal lesions who have sought bronchoscopic C-TBNA service at the Bronchoscopy Unit of both Ain Shams University Hospital and Giza Chest Hospital during the period from June 2016 to February 2018.

Results

The overall C-TBNA had a diagnostic yield of 88.3% in which 68.3% were malignant and 20% had sarcoidosis without serious complications recorded except for minor non-life-threatening bleeding in 21.7% of cases. After 6 months of C-TBNA learning experience, the diagnostic yield showed improvement in physicians without previous C-TBNA experience, but without reaching a statistical significance. Also, there were significant reduction in both duration and complications of C-TBNA.

Conclusion

Implementing C-TBNA service in a tertiary care chest hospital in bronchoscopically nonvisible extraluminal lesions seems to be a safe, easy technique with high diagnostic yield and its learning performance was able to be improved over time.

References

  1. Holty JE, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non small cell lung cancer :a metaanalysis. Thorax 2005; 60:949–955.

    Article  Google Scholar 

  2. Jacob G, Sean G, Alain T. Mediastinal staging for lung cancer. Can Respir J 2014; 21:159–161.

    Article  Google Scholar 

  3. Melloni G, Bandiera A, Muriana P, Sestini S, Picchio M, Zannini P. Combined use of TBNA and EBUS-TBNA in the preoperative staging of lung cancer patients. J Bronchology Interv Pulmonol 2011; 18:311–316.

    Article  Google Scholar 

  4. Herth F, Becker HD, Ernst A. Conventional vsendobronchial ultrasound-guided transbronchial needle aspiration:a randomized trial. Chest 2004; 125:322–325.

    Article  Google Scholar 

  5. Fiorelli A, Rambaldi P, Vicidomini G, di Serio U, Accardo M, Rotondo A, Santini M. Combined transbronchial needle aspiration and (99m)Tc-2-methoxyisobutyl-isonitrile single photon emission computed tomography for diagnosing enlarged mediastinal lymph nodes. Arch Bronconeumol 2014; 50:3–9.

    Article  Google Scholar 

  6. Haponik EF, Shure D. Underutilization of transbronchial needle aspiration:experiences of current pulmonary fellows. Chest 1997; 112:251–253.

    Article  CAS  Google Scholar 

  7. Madkour A, Al Halfawy A, Sharkawy S, Zakzouk Z. Survey of adult flexible bronchoscopy practice in Cairo. J Bronchology Interv Pulmonol 2008; 15:27–32.

    Google Scholar 

  8. British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee of Standards of Care Committee of British Thoracic Society. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax 2001; 56:i1–i21.

    Google Scholar 

  9. Du Rand IA, Barber PV, Goldring J, Lewis RA, Mandal S, Munawar M, British Thoracic Society Bronchoscopy Guideline Group. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011; 66:1–21.

  10. Minai OA, Dasgupta A, Mehta AC. Transbronchial needle aspiration of central and peripheral lesions. In:Bolliger CT, Mathur PN, editors. Interventional bronchoscopy. Basel, Switzerland:Karger 2000. 30. pp. 69–71.

  11. Hsu LH, Liu CC, Ko JS. Education and experience improve the performance of transbronchial needle aspiration. Chest 2004; 125:532–540.

    Article  Google Scholar 

  12. Hermens FH, van Engelenburg TC, Visser FJ, Thunnissen FB, Termeer R, Janssen JP. Diagnostic yield of transbronchial histology needle aspiration in patients with mediastinal lymph node enlargement. Respiration 2003; 70:631–635.

    Article  Google Scholar 

  13. Cetinkaya E, Yildiz P, Altin S, Yilmaz V. Diagnostic value of transbronchial needle aspiration by Wang 22-gauge cytology needle in intrathoracic lymphadenopathy. Chest 2004; 125:527–531.

    Article  Google Scholar 

  14. Shah PL, Singh S, Bower M, Bower M, Livni N, Padley S, Nicholson AG. The role of transbronchial fine needle aspiration in an integrated care pathway for the assessment of patients with suspected lung cancer. J Thorac Oncol 2006; 1:324–327.

    Article  Google Scholar 

  15. Khattab A. Transbronchial needle aspiration in the diagnosis and staging of intra thoracic malignancies [thesis]. Cairo, Egypt:Ain Shams University; 1986.

    Google Scholar 

  16. Mohamed SAA, Ahmed Y, Hussein KH, Abd El-aziz NM, Gamal Y. Diagnostic utility of transbronchial needle aspiration in malignant endobronchial lesions:relevance to lesions characteristics. J Respir Med 2013; 2013:756483.

    Article  Google Scholar 

  17. Lannes D, Monterio AS, Toscano E, Cavalcanti A, Nascimento M, de Biasi P, Zamboni M. Transbronchial needle aspiration of hilar and mediastinal lymph nodes. Rev Port Pneumol 2007; 13:651–658.

    PubMed  Google Scholar 

  18. Samaha H, Moawad A, Shebl A. Yield of transbronchial needle aspiration of mediastinal lymph nodes of 36 cases. Egypt J Chest Dis Tuberc 2015; 64:745–748.

    Article  Google Scholar 

  19. Hewidy A, Shebl A. Efficacy and safety of bronchoscopic diagnostic procedures of sarcoidosis:a retrospective study. Egypt J Chest Dis Tuberc 2016; 65:473–478.

    Article  Google Scholar 

  20. Szlubowski A, Kuzdzal J, Soja J, Laczynska E, Hauer J, Kopinski P, et al. Transbronchial needle aspiration as a diagnostic method in lung cancer and non-malignant mediastinal adenopathy. Pneumonol Alergol Pol 2007; 75:5–12.

    PubMed  Google Scholar 

  21. Tutar N, Buyukoglan H, Yilmaz I, Kanbay A, Onal O, Bilgin M, et al. Learning curve of conventional transbronchial needle aspiration. Clin Respir J 2014; 8:79–85.

    Article  Google Scholar 

  22. Sharafkhaneh A, Baaklini W, Gorin AB, Green L. Yield of transbronchial needle aspiration in diagnosis of mediastinal lesions. Chest 2003; 124:2131–2135.

    Article  Google Scholar 

  23. Walia R, Madan K, Mohan A, Jain D, Hadda V, Khilnani GC, Guleria R. Diagnostic utility of conventional transbronchial needle aspiration without rapid on-site evaluation in patients with lung cancer. Lung India 2014; 31:208–211.

    Article  Google Scholar 

  24. Harrow EM, Abi-Saleh W, Blum L, Harkin T, Gasparini S, Addrizzo-Harris DL, et al. The utility of transbronchial needle aspiration in the staging bronchogenic carcinoma. Am J Respir Crit Care Med 2000; 161:601–607.

    Article  CAS  Google Scholar 

  25. De Castro FR, Diaz-Lopez F, Serda GJ, López AR, Gilart JF, Cabrera Navarro P. Relevance of training in transbronchial fine needle aspiration technique. Chest 1997; 111:103–105.

    Article  Google Scholar 

  26. Haponik EF, Gappellari JO, Chin R, Adair NE, Lykens M, Alford PT, Bowton DL. Education and experience improve the performance of transbronchial needle aspiration. Am J Respir Crit Care Med 1995; 151:1998–2002.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest, Faculty of Medicine, Ain Shams University, 2111, Cairo, Egypt

    Mohammed A. Farrag, Gehan M. El Assal, Ashraf M. Madkour & Nehad M. Osman MD

  2. Giza Chest Hospital, Giza, Egypt

    Manar H. Taha

Authors
  1. Mohammed A. Farrag
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gehan M. El Assal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashraf M. Madkour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nehad M. Osman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manar H. Taha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nehad M. Osman MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farrag, M.A., El Assal, G.M., Madkour, A.M. et al. Implementation of bronchoscopic conventional transbronchial needle aspiration service in a tertiary care chest hospital. Egypt J Bronchol 13, 309–313 (2019). https://doi.org/10.4103/ejb.ejb_95_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_95_18

Keywords