title: Conventional transbronchial needle aspiration decreases the rate of surgical sampling of intrathoracic lymphadenopathy.
abstract: BACKGROUND
  Previous studies have suggested a decreased need for the surgical biopsy of intrathoracic lymph nodes (LNs) due to improved diagnostic rates utilizing transbronchial needle aspiration (TBNA) with endobronchial ultrasound and endoscopic ultrasound. The goal of this study was to determine whether conventional TBNA using combined cytologic and histologic analysis of tissue specimens impacted the rates of surgical diagnostic biopsies of patients with intrathoracic lymphadenopathy.
  
  
  METHODS
  Retrospective review at a single academic center. All mediastinal and hilar tissue samples submitted for pathologic analysis over an 8.4-year period were analyzed. Patients were categorized into a "before" group and an "after" group based on two different time periods. The before group underwent only cytologic analysis of Wang needle (19-gauge or 21-gauge) aspirates. The after group had cytologic analysis of aspirates as well as histologic analysis of needle "core" (19 gauge) biopsy specimens. The groups were compared for the rate of intrathoracic LNs sampled by surgical means vs TBNA and the number of times that TBNA averted the need for a surgical diagnostic procedure.
  
  
  RESULTS
  The success of TBNA increased significantly in the after group compared to that in the before group. The yield for the successful sampling of mediastinal and hilar LNs increased from 53 to 91% (p < 0.001) in the before group vs the after group. TBNA averted a surgical biopsy in 35% of the before cases compared to 66% of the after cases (p < 0.001).
  
  
  CONCLUSIONS
  Conventional TBNA using large-bore needles with both cytology and surgical pathology evaluation decreases the need for surgical sampling of the mediastinum to diagnose thoracic lymphadenopathy.
authors.affiliation: Columbia University Medical Center, New York, NY. Electronic address: np2199@columbia.edu.
authors.forename: Nina M
authors.initials: NM
authors.lastname: Patel
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Anne
authors.initials: A
authors.lastname: Pohlman
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Aliya
authors.initials: A
authors.lastname: Husain
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Imre
authors.initials: I
authors.lastname: Noth
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Hall
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: John P
authors.initials: JP
authors.lastname: Kress
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013896:Thoracic Diseases / Q000473:pathology*; D013908:Thoracotomy