Flexible transbronchial needle aspiration biopsy for histologic specimens

Flexible transbronchial needle aspiration (TBNA) biopsy has been used to obtain cytologic specimens from mediastinal lymph nodes for the diagnosis and staging of bronchogenic carcinoma. The dependency on a sophisticated cytologic laboratory, the skill required to perform this procedure, and the inability to obtain enough tissue to diagnose noncarcinomatous processes in the mediastinum by smaller needles has limited its use. The application of TBNA would be greatly enhanced if a histologic specimen could be obtained from the mediastinal lymph node safely. For this reason, an 18-gauge needle was developed and used through a rigid bronchoscope. In ten patients, adequate tissue for histology was obtained in nine, and a specific diagnosis was made in eight patients without any complication. A similar technique was developed and is now reported using the flexible bronchoscope. We conclude that using a flexible transbronchial needle is an effective and safe way of obtaining histologic specimens from the mediastinum and can provide a diagnosis, both in malignant and benign mediastinal disease. Hopefully, this technique will further reduce the need for more invasive surgical procedures.