Transbronchial Needle Aspiration

Background: Bronchoscopy with transbronchial needleaspiration (TBNA) is valuable to diagnose lesions in the mediastinumand lung, but conventional fluoroscopic guidance may be suboptimal. Wedescribe the use of CT fluoroscopy to provide real-time, transaxial, TBNA localization, thus facilitating biopsy. Methods: Patients were selected because of prior unsuccessful bronchoscopy oranticipated difficulty owing to small size or inaccessibility of thelesion. CT fluoroscopy consists of a spiral CT scanner adapted using arapid-reconstruction algorithm and hardware that permits real-timein-room imaging. The bronchoscope was inserted on the CT scanner, whichwas used to guide TBNA instruments into the target lesion. Results: Of 27 patients who underwent TBNA with CTfluoroscopic assistance, 15 had mediastinal nodes, and 12 had lungnodules or focal infiltrates. Mean lesion size was 1.7 cm in themediastinum, 2.2 cm in the lung. A correct diagnosis was established in10 of 12 mediastinal lesions (83%) for which follow-up was availableand in 8 lung lesions (67%). Diagnoses included small cell andnon-small cell lung cancer and invasive aspergillosis. False-negativeresults were caused by sampling errors or inability to reach the lesionas documented by CT fluoroscopy. Postprocedure CT fluoroscopy revealedno complications. Conclusion: CT fluoroscopy provideseffective, real-time guidance for TBNA and may be particularly valuablein patients with small or less accessible mediastinal or lunglesions.