The role of transcarinal needle aspiration in the diagnosis and staging of lung cancer: computed tomographic correlates of a positive result.
BACKGROUND
Transbronchial needle aspiration (TBNA) is used most frequently to assess subcarinal nodes because of its technical ease.


OBJECTIVE
We conducted a prospective observational clinical study to define the indications for TBNA use for subcarinal nodes (transcarinal needle aspiration, TCNA) related to the nodal size by computed tomography (CT) of the chest.


METHODS
One hundred and eight consecutive patients with lung cancer underwent TCNA at the time of initial diagnostic bronchoscopy within a 22-month period.


RESULTS
TCNA was positive in 21 of the patients. Only 1 of 75 patients (1%) with subcarinal nodes less than 10 mm in short-axis diameter by CT had a positive result. TCNA for enlarged nodes, 10 mm or greater, had a high positive yield of 61% (20/33). The procedure provided the only evidence of unresectable non-small cell lung cancer (stage IIIA-N2 disease) in 3 patients and the sole pathological evidence for malignancy in 5 patients.


CONCLUSIONS
The high yield of positive TCNA results for enlarged subcarinal nodes contributes to the improvement of the overall diagnostic yield of bronchoscopy. We recommend that TCNA for enlarged subcarinal nodes on CT in patients with presumptive lung cancer should be performed routinely at the time of initial diagnostic bronchoscopy.
Department of Respiratory Medicine, Nagoya National Hospital, Nagoya 460-0001, Japan. Masahideo@aol.com
Masahide
M
Oki
Hideo
H
Saka
Akifumi
A
Kumazawa
Chieko
C
Sako
Maki
M
Ando
Atsushi
A
Watanabe
D001707:Biopsy, Needle / Q000379:methods; D001980:Bronchi; D001999:Bronchoscopy; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D011446:Prospective Studies; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D014132:Trachea