united of the more exciting modern...

united of the more exciting modern developments in fiberoptic bronchoscopy has been transbronchial needle aspiration (TBNA). Not surprisingly, the evaluation of this transaction has had two distinct phases which parallel the rigid and fiberoptic eras of bronchoscopy During the early expansion of diagnostic applications of rigid bronchoscopy needle small hole of the trachea and proximal bronchi became a valuable adjunct in the diagnosis of bronchogenic carcinoma and in the evaluation of hemodynamic measurements.[1] Reasons for this lessening of interest in the technique, as thinked by published reports if not from numbers of procedures, are unclear. It is likely that Carlens' introduction of mediastinoscopy in 1959 and the ready acceptance of this safe and effective approach to diagnosis and staging of mediastinal disease is the greatest in number probable contributing factor. There has been no account of untoward issue or problem with the procedure

During the past five years, the design of an array of flexible needle has lengthen outed these procedures to fiberoptic bronchoscopy making it more generally available to chest clinicians and their patients.[2,3] As with other biopsy techniques, initial reports emphasizing the safety and diagnostic efficacy of the proceeding have yielded to investigations extending its applications, addressing limitations of technique identified in early studies, and critically reappraising its worth in patient management. In this regard, phases of enthusiastic introduction, critical re-evaluation, modification, and acceptance of TBNA are representative of those seen in the shooting and acceptance of other lung biopsy procedures

After the lucky adaptation of TBNA to the flexible bronchoscope by dint of cytology needle, another major innovation has been achieved by the agency of the design of a flexible cutting needle which permitted histologic specimens. In 25 patients, Wang obtained cores of tissue from the mediastinum and hilar areas. This biopsy was diagnostic in 18 patients, and included five patients with sarcoidosis. There were no complications, and in particular, bleeding was not increased despite the use of the 18 gauge needle[45] Preliminary experience with the same prototype needle at other institutions has supported the feasibility and safety of this histologic step Mehta et al[4] construct that a diagnosis was established in couple of five patients with extrinsic compression proper to lymphadenopathy.[6] Schenk et al (in this issue, papal court page 272) reported diagnostic histologic specimens in 20 of 29 patients undergoing flexible needle biopsies. There were no complications. These authors ground this new approach enhanced the sensitivity of TBNA according to cytology and concluded that all patients with bronchogenic carcinoma with a radiologically apparent mediastinal lymphadenopathy should endure this histogic staging procedure.

While we are stressing that transbronchial needle aspiration exhibits one exciting example of a just discovered or more properly, rediscovered and refined progressive growth of modern bronchology, this process itself should not receive disproportionate emphasis. Rather, TBNA is entirely one of the many tools available to the chest clinician, better adapting the use of bronchoscopy to overall diagnostic and management strategies, and affording greater latitude in meeting the exigencys of individual patients. It is in these latter areas, rather than as a technologic advance, that the real value of TBNA resides.[7]

REFERENCES

1 Schieppati E Mediastinal lymph node pierce through the tracheal carina. Surg Gynecol Obstet 1958; 100:243-46

2 Wang KP Terry P Transbronchial needle aspiration in the diagnosis and staging of lung cancer. Am Rev Respir Dis 1983; 127:344-47

3 Gittlen SD Erozan Y Wang KP A strange versatile transbronchial cytology needle for the staging and diagnosis of bronchogenic carcinoma. Chest 1988; 94:561-65

4 Wang KP Flexible transbronchial needle aspiration biopsy for histologic specimens. Chest 1985; 88:860-63

5 Wang KP Flexible bronchoscopy with transbronchial needle aspiration for histologic specimen. In: Wang KP ed Biopsy techniques in pulmonary disorders. recent York: Raven Press, 1989

6 Mehta AC, Nunez C Stoller JK Ahmad M Diagnostic usefulness of transbronchial needle aspiration with an 18 gauge needle Chest 1987; 92:148 7 Haponik E Decision making and patient management. In: Wang KP ed Biopsy techniques in pulmonary disorders. fresh York: Raven Press, 1989

COPYRIGHT 1989 American corporation of Chest Physicians

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