The Essential cTBNA Bronchoscopist

Recommendations

Info

Question I.26 When would you prefer transbronchial needle aspiration over a biopsy forcepsfor the diagnosis of an endobronchial lesion?A. Presence of fleshy vascular endobronchial growth with high risk of bleeding.B. Inadequate tissue sampling due to the presence of excessive necrosis.C. Presence of a blood clot over the lesion.D. Formation of crush artifacts by flexible bronchoscopy.E. All of the above.Answer: EcTBNA has an established use and value in the diagnosis of mediastinal and hilar adenopathy.Additionally, it is a useful and safe bronchoscopic technique in the diagnosis of bronchogeniccarcinoma. When diagnosing endobronchial lesions, cTBNA can be preferred over forcepsbiopsy in order to decrease the risk of complications such as bleeding, as well as to increasediagnostic yield.Usually, the needle is inserted into a visible exophytic intrabronchialabnormality, or into a submucosal infiltrating lesion. In these cases, the procedure is oftenreferred to as Endobronchial Needle Aspiration (EBNA). This procedure may be preferredinstead of endobronchial forceps biopsy or brushing in several instances. For example, thepresence of a fleshy vascular endobronchial growth increases the risk of bleeding when forcepsbiopsy is used instead of a cTBNA/EBNA. Excessive presence of necrosis or blood clot over thelesion may also make EBNA preferable over forceps biopsy. Furthermore, EBNA obtainsspecimens without forceps biopsy-related crush artifacts that makes slide interpretationdifficult. Several studies show an added benefit of performing endobronchial EBNA instead ofor in addition to biopsy and brushing. The goal is to obtain a good cytology or core sample. Itmay be best, therefore, to enter exophytic intrabronchial tumors as perpendicularly (at 90degrees) as possible, and to approach submucosal tumors from a 30-45 degree angle, in order toget as deep into the lesions as possible. Diagnostic yield of EBNA in both submucosal andexophytic tumors is often greater than 90%.46
Example of an endobronchial lesion with excessive necrosis presentwhere cTBNA (also called EBNA) should be preferred over biopsyforceps for diagnosis.References1. Shital P, Rujuta A, Sanjay M. Transbronchial needle aspiration cytology (TBNA) inendobronchial lesions: a valuable technique during bronchoscopy in diagnosing lungcancer and it will decrease repeat bronchoscopy. J Cancer Res Clin Oncol 2014;140:809-815.47
Page 2 and 3: FIRST EDITIONThe EssentialcTBNA Bro
Page 4 and 5: The Essential cTBNABronchoscopistCo
Page 6 and 7: Bronchoscopy International, Laguna
Page 8 and 9: Funding statementFunding for The Es
Page 11 and 12: MODULE 1THIRTY MULTIPLE CHOICE QUES
Page 13 and 14: Question I.1 The right pulmonary ar
Page 15 and 16: Question I.3 While performing trans
Page 17 and 18: Question I.5 Where are the right pa
Page 19 and 20: Aortic archNeedle through bifurcati
Page 21 and 22: Question I.8 Which of the following
Page 23 and 24: needle through the airway wall. Onc
Page 25 and 26: Question I.11 A patient with subcar
Page 27 and 28: Question I.12 Flexible bronchoscopy
Page 29 and 30: Proposed indications include stagin
Page 31 and 32: Question I.15 Which of the followin
Page 33 and 34: Question I.17 After two aspirates f
Page 35 and 36: Question I.18 While performing cTBN
Page 37 and 38: Question I.19 A patient is referred
Page 39 and 40: Question I.20 While performing cTBN
Page 41 and 42: Question I.22 A 39-year-old man wit
Page 43 and 44: Question I.23 During a cTBNA stagin
Page 45 and 46: may develop unless flow, respirator
Page 47: helps identify multiloculation and
Page 51 and 52: Example of transbronchial needle as
Page 53 and 54: Question I.29 A 69 year old smoker
Page 55 and 56: management.References1. Herth F, Be
Page 57 and 58: insertion depth of the needle. By t
Page 59 and 60: CONGRATULATIONSYou have now complet
Page 61 and 62: The Essential cTBNA BronchoscopistM
Page 63 and 64: Question 8.Each of the following is
Page 65 and 66: ANSWERSTO MODULE 1, TWELVE QUESTION
Page 67 and 68: CONGRATULATIONSYou have now complet
Page 69 and 70: CONTRIBUTORSHenri Colt M.D. is Prof
Page 71: THE ESSENTIAL cTBNA BRONCHOSCOPIST

The Essential cTBNA Bronchoscopist

Create successful ePaper yourself

Delete template?

Save as template?