Self-Learning Experience in Transbronchial Needle Aspiration in Diagnosis of Intrathoracic Lymphadenopathy
Viboon Boonsarngsuk MD*, Atcharaporn Pongtippan MD**
Affiliation : * Division of Pulmonary and Critical Care Medicine, Department of MedicineFaculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Cytology Unit, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Lack of a training program and experience result in underutilized transbronchial needle
aspiration (TBNA). Pulmonologists who are not graduated from Europe or the United States might have little
chance to learn and gain experience in this procedure.
Objective : To determine the authors’ diagnostic yield from self-learning TBNA in diagnosis of intrathoracic
lymphadenopathy.
Material and Method: After reviewing a videotape recorded TBNA procedure repetitively and receiving
training in tracheobronchial lung model, the authors performed TBNA according to standard techniques
using 21-guage cytology needles connected to a flexible bronchoscope in diagnosis of intrathoracic
lymphadenopathy and performed data collection on all TBNA procedures at Ramathibodi Hospital, a tertiary
university hospital in Bangkok, Thailand between January 1, 2006 and December 31, 2007.
Results : Thirty-eight consecutive patients were examined. Twenty-seven nodes (71.1%) were malignancies
and 11 nodes (28.9%) were benign diseases. During the first 6-month, the authors’ diagnostic yield and
frequency of adequate specimens were low. With some modification of the TBNA technique and learning
experience, the frequency of inadequate specimens significant decreased from 36.4% to 0% (p = 0.03).
Although the diagnostic yield increased from 45.5% to 84.6%, it did not reach statistical significance (p =
0.09). No complication, in either the patients or the bronchoscopes, was found.
Conclusion : TBNA is a safe procedure that can be self-mastered by pulmonologists with interest, intent, and
who exert themselves. TBNA performance will be improved over time with practice.
Keywords : Transbronchial needle aspiration, Fiberoptic bronchoscopy, Lymph node, Diagnostic yield
