Yield of transbronchial needle aspiration in diagnosis of mediastinal lesions

Chest. 2003 Dec;124(6):2131-5. doi: 10.1378/chest.124.6.2131.


Study objectives: To determine the transbronchial needle aspiration (TBNA) yield for procedures performed by fellows in training, and the predictors of positive TBNA yield at our center.

Design: Retrospective chart review.

Setting: A tertiary teaching hospital.

Patients: One hundred seventy patients who underwent fiberoptic bronchoscopy with TBNA of mediastinal lesions from January 1991 to July 1999.

Results: Final diagnoses were available for 166 patients. TBNA was diagnostic in 104 patients (61%) and nondiagnostic in 66 patients (39%). Of 170 cases, 123 patients (72%) had malignancies, 30 patients (18%) had benign disease, and 13 patients (8%) were normal. Of 123 malignancies, 85 patients (69%) had a positive result by TBNA. Of 30 cases with benign disease, 11 patients (37%) had positive TBNA findings. Eight of 13 patients (62%) with a normal diagnosis had diagnostic TBNA (normal lymphoid tissue). There were statistically significant correlations between TBNA result and cell type of the lesion (p < 0.001), size of the lesion (p < 0.05), and type of malignancy (small cell carcinoma more than non-small cell carcinoma more than lymphoma, p < 0.05). We did not find any significant difference for aspiration yield between carinal and tracheal sites (p > 0.05). Logistic regression analysis indicated that the presence of malignancy is the major determinant of TBNA yield (p = 0.009). In addition, lesion size does affect yield after being adjusted for diagnosis (one-sided p = 0.04).

Conclusions: TBNA is a minimally invasive diagnostic technique with a high yield, even in hands of less experienced operators. Malignancy, lesion size, and type of malignancy are major determinants of TBNA yield.

MeSH terms

  • Biopsy, Needle
  • Bronchoscopy / methods*
  • Fiber Optic Technology
  • Humans
  • Logistic Models
  • Mediastinal Diseases / classification
  • Mediastinal Diseases / diagnosis*
  • Mediastinal Diseases / pathology
  • Mediastinal Neoplasms / diagnosis
  • Mediastinal Neoplasms / pathology
  • Retrospective Studies
  • Sarcoidosis, Pulmonary / diagnosis
  • Sarcoidosis, Pulmonary / pathology