Mediastinal lymphadenopathy: Diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance - Initial experience

PURPOSE: To determine whether the use of computed tomographic (CT) fluorosc opy to guide transbronchial needle aspiration (TBNA) of mediastinal lymph n odes can improve the diagnostic yield. MATERIALS AND METHODS: CT fluoroscopy was used to guide TBNA in 12 consecut ive patients with mediastinal lymphadenopathy who had previously undergone nondiagnostic conventional TBNA. CT fluoroscopy was used to confirm the loc ation of the biopsy needle by using a "quick-check" technique (ie, fluorosc opy was performed sparingly after needle insertion). The location of each n eedle, the total procedural and fluoroscopic times, and any complications w ere recorded. RESULTS: All CT fluoroscopic procedures were performed in less than 1 hour, and a tissue diagnosis was established in all patients. Eighteen lymph nod es with a diameter of 0.8-2.4 cm were sampled with 116 needle passes. CT fl uoroscopy documented inadequate positioning in 48 of the 116 (41.3%) needle passes. Eighteen (15.5%) needles did not fully penetrate the tracheobronch ial tree. Six needles (5.2%) were placed into the great vessels. Malignant disease was diagnosed in nine patients, and benign disease was diagnosed in three. The mean fluoroscopic exposure time was 20.5 seconds +/- 12.7. No p neumothoraces or substantial hemorrhage were observed. CONCLUSION: CT fluoroscopic guidance for TBNA procedures is a safe and effi cient means of providing diagnostic material and should be considered for p atients who have previously undergone nondiagnostic blinded TBNA.