The Essential cTBNA Bronchoscopist
The Essential Conventional TBNA Bronchoscopist© is the third of six volumes in The Essential Bronchoscopist™ Series. In addition to module-specific competency-oriented learning objectives and post-tests, it contains 30 multiple-choice question/answer sets pertaining to conventional transbronchial needle aspiration (cTBNA). Topics include mediastinal anatomy, proper equipment handling, patient preparation, procedural indications contraindications and complications, bronchoscopic techniques, nodal sampling strategies, lung cancer staging and classification, specimen collection, processing, and expected results for diagnosing malignant and benign mediastinal disorders.
The Essential Conventional TBNA Bronchoscopist© is the third of six volumes in The Essential Bronchoscopist™ Series. In addition to module-specific competency-oriented learning objectives and post-tests, it contains
30 multiple-choice question/answer sets pertaining to conventional transbronchial needle aspiration (cTBNA). Topics include mediastinal anatomy, proper equipment handling, patient preparation, procedural indications contraindications and complications, bronchoscopic techniques, nodal
sampling strategies, lung cancer staging and classification, specimen collection, processing, and expected results for diagnosing malignant and benign mediastinal disorders.
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Question I.4 During transbronchial needle aspiration of mediastinal lymphadenopathy, which
of the following is most likely to help increase diagnostic yield?
A. Performing needle aspiration before airway examination or acquisition of other samples.
B. Maintaining suction during needle withdrawal from the lymph node.
C. Rinsing the working channel of the bronchoscope before needle insertion.
D. Asking the cytopathologist to be present to immediately examine the specimens.
Answer: D
Several studies have shown that Rapid OnSite Examination of cTBNA specimens by a trained
cytopathologist (ROSE) improves diagnostic yield. In addition, this might allow the
bronchoscopist to perform fewer needle passes, and might make additional specimens such as
biopsies or brushing less necessary. Most experts recommend rinsing the working channel prior
to performing needle aspiration. In addition, in order to avoid false positive results, needle
aspiration should be performed prior to airway inspection or biopsies of endobronchial
abnormalities. Once the needle (ususally 22G cytology needle) is inserted through the airway
wall and into the tumor or lymph node, suction is applied to obtain the sample. Suction should
be released prior to removing the needle from the tumor or lymph node in order to avoid avoid
contamination from bronchial wall tissue. The bronchoscope should not be connected to wall
suction until all needle aspiration samples have been obtained. Using a larger histology needle
(19G) might result in greater yield, especially for diagnosis of lymphoma.
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