TRANSBRONCHIAL NEEDLE ASPIRATION (TBNA) INFECTED WITH HIV

Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes h as been shown to be useful in the diagnosis and staging of bronchogeni c carcinoma. With the exception of sarcoidosis, the usefulness of TBNA has not been widely investigated in other clinical settings. We inves tigated the utility of TBNA with a 19-gauge histology needle in HIV-in fected patients with mediastinal and hilar adenopathy at Bellevue Hosp ital Center. We performed 44 procedures in 41 patients. Adequate lymph node sampling was obtained in 35 of 44 (80%), and diagnostic material was obtained in 23 of 44 (52%) procedures. TBNA was the exclusive mea ns of diagnosis in 13 of 41 (32%) patients. Of the 44 procedures, 23 ( 52%) were performed in patients with mycobacterial disease, with TBNA providing the diagnosis in 20 of 23 (87%). In these patients, positive TBNA specimens included smears of aspirated materials for acid-fast b acilli in 11, mycobacterial culture in 14, and histology in 15. In oth er diseases, TBNA diagnosed sarcoidosis with noncaseating granulomata in 2 of 4 patients and non-small cell lung cancer in 1 of 2 patients. TBNA was not helpful in other diseases including Pneumocystis carinii, pneumonia, infection with Cryptococcus or Nocardia, bacterial pneumon ia, viral pneumonia, and Kaposi's sarcoma. No pulmonary diagnosis was established in five patients. No complications of TBNA occurred. We co nclude that TBNA through the flexible bronchoscope is safe and effecti ve in the diagnosis of intrathoracic adenopathy in HIV-infected patien ts, and is particularly efficacious in the diagnosis of mycobacterial disease. Furthermore, TBNA may provide the only diagnostic specimen in almost one-third of HIV-infected patients, thereby sparing these pati ents more invasive procedures such as mediastinoscopy.