Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies.
BACKGROUND
The aim is to assess the validity and reliability of transbronchial needle aspiration (TBNA) of mediastinal and hilar adenopathies and to evaluate factors predictive of TBNA outcome.


METHODS
We performed an analysis of prospectively collected data of patients (n = 580) who underwent TBNA (n = 685) from January 1998 to December 2007 in our center. Validity and reliability were evaluated for the overall sample and according to specific pathology. Factors predicting the successful acquisition of diagnostic samples were analyzed by multivariate analysis.


RESULTS
Overall sensitivity, specificity, accuracy, and positive and negative predictive (NPV) values for TBNA were 68%, 100%, 68.8%, 100%, and 10%, respectively. The most sensitive and accurate TBNAs were obtained for patients with small cell lung carcinoma and the worst results were for patients with lymphomas. NPV were similar for all pathologies. The most predictive factors of outcome were adenopathy size and the presence of indirect signs at the puncture site.


CONCLUSIONS
The sensitivity and accuracy of TBNA are high in small cell lung cancer, followed by other types of carcinoma, sarcoidosis, and tuberculosis, and low for lymphoproliferative diseases. The NPV of TBNA for all individual pathologies is low. The size of the adenopathy and the presence of indirect signs at the puncture site predict the achievement of diagnostic samples.
Fernández-Villar
Alberto
A
Bronchoscopy Unit, Pulmonary Department, Xeral-Cíes Hospital, University Hospitalary Complex of Vigo, C/Pizarro 22; 36204 Vigo, Spain. alberto.fernandez.villar@sergas.es
Botana
Maribel
M
Leiro
Virginia
V
González
Ana
A
Represas
Cristina
C
Ruano-Raviña
Alberto
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis* / Q000473:pathology*