COMPARISON OF THE WANG 19-GAUGE AND 22-GAUGE NEEDLES IN THE MEDIASTINAL STAGING OF LUNG-CANCER

Transbronchial needle aspiration (TBNA) offers the unique opportunity to pathologically stage patients with lung cancer at the time of diagn ostic bronchoscopy. The purpose of this study was to compare the stagi ng sensitivities of the Wang 22-gauge and 19-gauge needles. We studied 64 patients with bronchogenic carcinoma and mediastinal adenopathy. B efore bronchoscopy each patient underwent chest CT. Three to four aspi rates were obtained with each needle from endotracheal sites adjacent to paratracheal lymphadenopathy In 47 patients malignant mediastinal a denopathy was confirmed by the 19-gauge needle. A total of 29 patients had malignant 22-gauge needle aspirates. Of the 64 patients, 9 had be nign, reactive mediastinal lymph nodes. There were 20 patients in whom only the 19-gauge needle demonstrated malignancy and 2 patients with malignant 22-gauge needle aspirates as the sole identifier of paratrac heal malignancy. As a staging tool, the 19-gauge needle was significan tly more sensitive than the 22-gauge needle, 85.5 versus 52.7% (p = 0. 0001). Overall, in 49 of 55 patients (89.1%) with malignant mediastina l lymphadenopathy paratracheal tumor was confirmed by TBNA. The 19-gau ge TBNA staging of the mediastinum is an effective, safe, and cost-sav ing alternative to surgical mediastinal exploration that can be perfor med during initial diagnostic bronchoscopy.