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A Journal on Surgery


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Minerva Chirurgica 2006 December;61(6):459-66

language: English

Diagnostic value and learning curve of transbronchial needle aspiration in thoracic surgery

Raveglia F., Meda S., Conforti S., Leporati A., Calati A. M., Squinzi R., Giuliani L., Mezzetti M.

Department of Thoracic Surgery San Paolo Hospital, Milan


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Aim.
Transbronchial needle aspiration (TBNA) is particularly indicated in
diagnosing mediastinal masses or lymphoadenopaty proximal to the
airways. Nowadays TBNA has not been widely accepted among pulmonologist
and thoracic surgeons. Since its correct management could reduce
patient morbidity we adopted this method. Here is presented an overview
of our experience over a 18-months training period.
Methods. Fifty patients underwent TBNA. They presented non diagnosed
paratracheal or peribronchial lymphadenopathy or masses of >1 cm.
TBNA has been considered in order to spare patients the need for more
invasive diagnostic procedures. TBNA has been performed with flexible
bronchoscope and 19-gauge or 21-gauge needle.
Results. We made diagnosis of disease in 25 of 41 patients whose
adequate sampling was obtained. 16 cases showed absence of disease
despite criteria for adequacy have been confirmed, 9 cases presented an
inadequate specimen. The overall diagnostic yield and sensitivity were
50% and 86%. The overall accuracy was 76%. Considering the last 6
months of the training period diagnostic yield increased from 18.7% to
88.2% (P<0.001),accuracy from 56.2% to 88.2% (P=0.04) and frequency
of inadequacy decreased from 43.7% to 11.7% (P=0.046).
Conclusions. TBNA resulted a successful diagnostic tool in selected
cases as it is safe and permits to spare patients the need for more
invasive procedures. These data revealed that experience is mandatory
in order to achieve acceptable results. We think that an experienced
operator should require a training period of approximately 50
procedures to obtain a good technique profiency.

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