The Essential cTBNA Bronchoscopist

Question I.27 A 42 year old female patient is diagnosed with a solitary pulmonary nodule of 2.8
cm in diameter. The lesion is PET positive, located on the right upper lobe, with bronchus sign
on thin-section computed tomography. No lymphadenopathy or distant metastases are noted.
A flexible bronchoscopy with endobronchial ultrasonography and fluoroscopy is scheduled.
Which of the following statements is TRUE?
A. A bronchial washing is usually adequate for diagnosis.
B. A combined use of transbronchial needle aspiration and transbronchial biopsy can
improve the diagnostic yield.
C. The use of transbronchial needle aspiration through the guide sheath should be avoided
due to increased risk of complications.
D. Surgery is the only option for diagnosis.
Answer: B
Endobronchial ultrasonography with a guide sheath has improved the diagnostic yield of
small-sized peripheral lung lesions. The use of fluoroscopy also helps increase the diagnostic
yield and safety of the procedure. The CT bronchus sign is a significant predictive factor for
successful bronchoscopic diagnosis. The use of a biopsy forceps for transbronchial biopsies
(TBBx) and conventional transbronchial needle aspiration (cTBNA) through the guide sheath
are effective and safe procedures for diagnosing peripheral pulmonary lesions. Additionally,
cTBNA is more helpful than TBBx when the guide sheath is located outside the lesion. TBBx,
cTBNA and transbronchial catheter aspiration are complementary techniques. Combining these
three techniques allows specimen collection from small lesions <3 cm in diameter during
conventional bronchoscopy.
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