TBNA versus TENA in the diagnosis and staging of bronchogenic carcinoma: "A comparative study"

BACKGROUND: Transbronchial needle aspiration (TBNA) through the flexible bronchoscope still remains underused and a poorly understood procedure. Recently, transesophageal needle aspiration (TENA) under ultrasound guidance has been used to help stage the posterior mediastinal lymph nodes. OBJECTIVE: TBNA and TENA have both been used for the diagnosis and staging of bronchogenic carcinoma. This study is to compare the efficacy and complimentary potential of these techniques. DESIGN: Retrospective review and comparison of a series of consecutive patients. SETTING: Tertiary referral hospital. PATIENTS: Nineteen adult patients with mediastinal adenopathy. INTERVENTIONS: TBNA and TENA. MAIN OUTCOME MEASUREMENTS: Specific diagnostic yield of TBNA compared with TENA in adenopathy of the left paratracheal and subcarinal locations. RESULTS: Out of 19 patients, specific diagnosis was made in 15 patients (79%) by TBNA and in 13 patients (68%) by TENA. TBNA and TENA were both positive in 5 patients. TBNA alone was positive in 7 patients and TENA alone was positive in 1 patient. In the comparative study group lymph node stations 7, 8, and 5 (L4), there were no significant differences in the diagnostic yield of TBNA and TENA. LIMITATIONS: Small sample size. CONCLUSIONS: TBNA remains highly effective for sampling mediastinal lymph node stations. TENA is limited for subcarinal, paraesophageal, and aorto-pulmonary window lymph nodes, which are adjacent to the esophagus. Adding TENA to TBNA did not increase the diagnostic yield even in these subgroups of lymph nodes in our study.