Conventional TBNA experience over a 10-year period: Diagnostic yield and associated limitations in a tertiary care government set-up.

INTRODUCTION: It is challenging for pulmonologists to sample mediastinal lymph nodes or some endobronchial lesions because of safety concerns. C-TBNA (conventional transbronchial needle aspiration) is a procedure to sample such sites, but is underutilized. We present a retrospective review of patients subjected to C-TBNA through fibre-optic bronchoscopy over a 10-year period.

MATERIALS AND METHODS: Year-wise statistics of C-TBNA was reviewed and results were analyzed with regard to sampling sites and type of intraluminal lesions encountered, diagnosis made and their correlation with sampling sites, sex and age.

RESULTS: 160 patients underwent successful C-TBNA with 111/160 (69.4%) males and 49/160 (30.6%) females. Non-availability of in-house needles dramatically decreased the number of procedures. 17 (10.6%) patients underwent C-TBNA from intraluminal bulge, 41 (25.6%) from endobronchial growth and 102 (63.8%) from enlarged lymph nodes. Subcarinal lymph node alone was predominantly aspirated in 83/102 (81.4%) lymph node sampled patients. In 100 (62.5%) patients, diagnosis was achieved as follows: 57/100 as tumour, 30/100 as infection and 13/100 as sarcoidosis. Non-small cell lung cancer (NSCLC) and tuberculosis (TB) predominated in tumour and infection groups, respectively. Patients with intraluminal growth or bulge had higher chances of being diagnosed with tumour (p<0.001). Intraluminal bulge and growth predominated in older ages while enlarged lymph nodes predominated in the young (p=0.018). Infection was predominantly diagnosed in younger patients, sarcoidosis in the middle aged, and tumour in older patients (p<0.001).

CONCLUSION: C-TBNA should be used as a diagnostic tool in developing countries like India. It can give confirmatory results in difficult cases with intraluminal growths and submucosal lesions. Cost constraints are of paramount importance, and hence continuous supply of expensive accessories should be ensured.