The Essential cTBNA Bronchoscopist

Proposed indications include staging the radiologically normal mediastinum in suspected or
confirmed lung cancer, mediastinal restaging after induction chemotherapy, and diagnosis of
mediastinal, hilar, peribronchial, paratracheal, or intrapulmonary masses. In this case, needle
aspiration of the lymph node as well as of the retrosternal goiter revealed clusters of follicular
cells consistent with benign thyroid tissue. It is noteworthy that cTBNA of high paratracheal
lymph nodes and paratracheal lesions can be difficult. In most cases today, operators prefer
using EBUS-guided TBNA if available in such instances. Furthermore, because cTBNA is
essentially a “blind” technique, there is no way to determine whether samples are coming from
necrotic or non-necrotic target areas, which might affect diagnostic yield and diminish (in case
only areas of necrosis are sampled) overall sensitivity of the procedure. Larger 19G histology
needles have been shown to increase diagnostic yield as compared to smaller 22 G cytology
needles in several studies (sometimes by up to 35%), but it can be more difficult to pass the
histology needle through the working channel of the flexible bronchoscope, and its use may not
be possible in every patient. When used, the histology needle allows retrieval of core specimens,
which may be particularly important to increase yield in patients with benign diseases such as
tuberculosis or histoplasmosis, sarcoidosis, or in patients with suspected or known lymphoma,
lung cancer, or metastatic cancers involving mediastinal lymph nodes.
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