title: Performance characteristics and predictors of yield from transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions.
abstract: OBJECTIVE
  Transbronchial needle aspiration (TBNA) is useful for diagnosing peripheral pulmonary lesions (PPL). However, TBNA is largely underused and the variables that may be related to its diagnostic usefulness have not been specifically studied. The aim of the present study was to evaluate the performance characteristics and predictors of yield from TBNA of PPL, and to compare the performance characteristics of different bronchoscopic sampling methods.
  
  
  METHODS
  Consecutive patients with PPL were prospectively enrolled, and during the same examination, TBNA, transbronchial lung biopsy (TBLB) and bronchial washing (BW) were performed.
  
  
  RESULTS
  Two hundred and eighteen PPL in 218 patients were sampled. TBNA was more sensitive (65%) than either TBLB (45%, P<0.001) or BW (22%, P<0.001). TBNA was the only diagnostic procedure in 42/196 patients (21%) with malignant lesions, and was more likely to be the only diagnostic procedure for lesions lacking (23/85 patients, 27%) than for lesions with the bronchus sign (19/111 patients, 17%). In multivariate analysis, a lesion size >2cm, malignancy and location in the middle lobe were independent predictors of a positive TBNA result.
  
  
  CONCLUSIONS
  TBNA is the single best contributor to the success of bronchoscopy in the diagnosis of PPLs, and should be routinely used especially in the presence of lesions lacking the bronchus sign. Lesion size of > 2cm, location in the middle lobe, and malignant nature are strong predictors of a positive TBNA result.
authors.affiliation: Thoracic Endoscopy and Pulmonology Unit Pathology Unit Thoracic Surgery Unit, Maggiore Hospital, Bologna Clinical Epidemiology and Biometry Service, IRCCS Policlinico San Matteo, Pavia, Italy. rocco.trisolini@ausl.bologna.it
authors.forename: Rocco
authors.initials: R
authors.lastname: Trisolini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cancellieri
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Daniela
authors.initials: D
authors.lastname: Paioli
authors.forename: Luigia
authors.initials: L
authors.lastname: Scudeller
authors.forename: Sergio Nicola
authors.initials: SN
authors.lastname: Forti Parri
authors.forename: Vanina
authors.initials: V
authors.lastname: Livi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Boaron
authors.forename: Marco
authors.initials: M
authors.lastname: Patelli
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012680:Sensitivity and Specificity