CT fluoroscopy guidance for transbronchial needle aspiration - An experience in 35 patients

Objective: To demonstrate the usefulness of real-time guidance with CT fluo roscopy to improve the yield of transbronchial needle aspiration (TBNA), Design: Prospective, observational, Setting: A tertiary-care, university-affiliated medical center. Methods: From December 1998 to April 2000, 35 patients underwent CT fluoros copy-guided TBNA, Patients with subcarinal and precarinal lymph nodes were only included if a previous attempt was nondiagnostic, as the initial yield in this setting with conventional TBNA is high. TBNA was performed using s tandard technique in a CT-scan suite. Needle location was confirmed with fl uoroscopy without IV contrast being used. Specimens were evaluated on-site for adequacy. Results: The procedure had to be aborted in three patients before TBNA coul d be performed. Samples were obtained in 32 patients. Samples were nondiagn ostic in four patients. Adequate tissue was obtained in 28 of 32 patients ( 87.5%), Twenty-two patients had a specific benign or malignant diagnosis ma de, and 6 patients had lymphocytes only on the specimen. In follow-up, only one of these six patients proved to have a malignancy. All procedures were pet-formed within a regular interventional CT time slot of 1 h. No TBNA si de effects were noted. Conclusion: TBNA under CT fluoroscopic guidance is easy to perform. The yie ld in all accessible lymph node stations is high.