Transbronchial needle aspirates: how many passes per target site?

¹ Depts of Internal Medicine, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
² Depts of Anatomical Pathology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa

^* To whom correspondence should be addressed. E-mail: ahd{at}sun.ac.za.

	Abstract

Transbronchial needle aspiration is a bronchoscopic sampling method for a variety of bronchial and pulmonary lesions. This study investigated whether and how serial needle passes contribute to the yield of transbronchial needle aspiration at specific target sites.

We prospectively recorded 1562 needle passes performed at 374 target sites rated for anatomical location, size, bronchoscopic appearance and underlying disease in 245 patients with neoplastic disease (82%), non-neoplastic disease (15%) or undiagnosed lesions (3%).

Positive aspirates were obtained in 75% of patients and in 68% of target sites. A diagnosis was established with the first, second, third and fourth needle pass at 64%, 87%, 95% and 98% of targets, respectively. The absolute yield varied strongly with target sites features, but the stepwise increment to the maximum yield provided by serial passes was similar across target sites.

Three transbronchial needle passes per site are appropriate when only a tissue diagnosis is sought and when alternative sites or sampling modalities are available. At least four or five passes should be carried out at lymph node stations critical for staging of lung cancer.

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