title: Exclusive diagnostic contribution of the histology specimens obtained by 19-gauge transbronchial aspiration needle in suspected malignant intrathoracic lymphadenopathy.
abstract: BACKGROUND
  Transbronchial needle aspiration (TBNA) performed with a 19-gauge needle provides both cytologic and histologic specimens. However, the diagnostic yield for malignancy gained by histologic examination is unclear. Moreover, this kind of needle is often reserved only for selected cases, in part due to fear for complications. The primary aim of this study was to investigate the diagnostic contribution for malignancy added by histologic to the cytologic specimen examination. The secondary aim was to evaluate the safety of using a 19-gauge needle routinely in all patients.
  
  
  METHODS
  Consecutive patients presenting with mediastinal and/or hilar lymph node enlargement of > or = 1 cm, in whom suspicion for malignancy was raised, underwent TBNA with a 19-gauge needle. Patients with negative aspirate test results underwent surgical investigation.
  
  
  RESULTS
  Among 77 patients who were examined, 66 had malignant intrathoracic lymphadenopathy. TBNA proved malignancy in 58 patients, whereas it missed the diagnosis in 8 patients (sensitivity, 87.9%; negative predictive value, 57.9%). TBNA established the diagnosis in 94% of patients with small cell lung cancer (SCLC), and in 88% of patients with non-SCLC (p = 0.7). Exclusive diagnosis was obtained in 36.4% of patients by histology (compared with 18.2% of patients by cytology [p = 0.06]), representing an increase of 35.3% in the diagnostic yield of TBNA over sole cytology examination. No major complication occurred.
  
  
  CONCLUSIONS
  Histology specimens obtained exclusively with a 19-gauge TBNA needle enabled diagnosis in about 36% of patients with malignant intrathoracic lymphadenopathy. The routine use of a 19-gauge needle is safe.
authors.affiliation: Critical Care and Respiratory Division, National and Kapodistrian University of Athens, Athens, Greece. grstrat@hotmail.com
authors.forename: Grigorios
authors.initials: G
authors.lastname: Stratakos
authors.forename: Ilias
authors.initials: I
authors.lastname: Porfyridis
authors.forename: Vassilis
authors.initials: V
authors.lastname: Papas
authors.forename: Christina
authors.initials: C
authors.lastname: Kandaraki
authors.forename: Charalampos
authors.initials: C
authors.lastname: Zisis
authors.forename: Vasso
authors.initials: V
authors.lastname: Mariatou
authors.forename: Adamantia
authors.initials: A
authors.lastname: Liapikou
authors.forename: Charis
authors.initials: C
authors.lastname: Roussos
authors.forename: Spyros
authors.initials: S
authors.lastname: Zakynthinos
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D001980:Bronchi; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013899:Thoracic Neoplasms / Q000150:complications / Q000473:pathology*