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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
SOD di Pneumologia Dipartimento di Medicina Interna Malattie Immuno-Allergiche e Respiratorie Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
Among the various methods of sampling cyto-histological material through the flexible bronchoscope, perhaps the most important developed innovation has been the introduction of transbronchial needle aspiration (TBNA). This technique has greatly expanded the diagnostic capabilities of bronchoscopy, allowing the bronchoscopist to go beyond the airways wall and to obtain specimens from hilar and mediastinal lesions. In the last years, TBNA has became an important technique in the staging of lung cancer as well as in the diagnostic approach to hilar and mediastinal pathological processes. Although numerous papers have demonstrated the accuracy and the safety of the procedure, TBNA continues to be largely underused. In this review, the technical requirements to successfully performe TBNA and the role that the technique plays in the management of lung cancer and in the diagnosis of several mediastinal pathologies, such as sarcoidosis, are described. The newer technique of guidance (endobronchial ultrasound and bronchoscopic electromagnetic navigation system), introduced to improve the TBNA sensitivity, are also described. Finally, the main reasons for the underuse of TBNA are analysed and discussed. On the basis of the literature evidence, TBNA should be considered as an essential tool that optimise the bronchoscopic activity and the management of patients with hilar-mediastinal lesions.