Mediastinal lymphadenopathy: Diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance - Initial experience

PURPOSE: To determine whether the use of computed tomographic (CT) fluoroscopy to guide transbronchial needle aspiration (TBNA) of mediastinal lymph nodes can improve the diagnostic yield. MATERIALS AND METHODS: CT fluoroscopy was used to guide TBNA in 12 consecutive patients with mediastinal lymphadenopathy who had previously undergone nondiagnostic conventional TBNA. CT fluoroscopy was used to confirm the location of the biopsy needle by using a "quick-check" technique (ie, fluoroscopy was performed sparingly after needle insertion). The location of each needle, the total procedural and fluoroscopic times, and any complications were recorded. RESULTS: All CT fluoroscopic procedures were performed in less than 1 hour, and a tissue diagnosis was established in all patients. Eighteen lymph nodes with a diameter of 0.8-2.4 cm were sampled with 116 needle passes. CT fluoroscopy documented inadequate positioning in 48 of the 116 (41.3%) needle passes. Eighteen (15.5%) needles did not fully penetrate the tracheobronchial tree. Six needles (5.2%) were placed into the great vessels. Malignant disease was diagnosed in nine patients, and benign disease was diagnosed in three. The mean fluoroscopic exposure time was 20.5 seconds +/- 12.7. No pneumothoraces or substantial hemorrhage were observed. CONCLUSION: CT fluoroscopic guidance for TBNA procedures is a safe and efficient means of providing diagnostic material and should be considered for patients who have previously undergone nondiagnostic blinded TBNA.