Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies
1 Bronchoscopy Unit, Pulmonary Department, Xeral-Cíes Hospital, University Hospitalary Complex of Vigo, C/Pizarro 22; 36204 Vigo, Spain
2 Patology Department, Xeral-Cíes Hospital, University Hospitalary Complex of Vigo, Spain
3 Galician Agency for Health Technology Assessment, Department of Health, Galician Regional Authority, Spain. Edif. Admtvo San Lázaro s/n. 15781 Santiago de Compostela Spain
4 Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain
BMC Pulmonary Medicine 2010, 10:24 doi:10.1186/1471-2466-10-24Published: 28 April 2010
The aim is to assess the validity and reliability of transbronchial needle aspiration (TBNA) of mediastinal and hilar adenopathies and to evaluate factors predictive of TBNA outcome.
We performed an analysis of prospectively collected data of patients (n = 580) who underwent TBNA (n = 685) from January 1998 to December 2007 in our center. Validity and reliability were evaluated for the overall sample and according to specific pathology. Factors predicting the successful acquisition of diagnostic samples were analyzed by multivariate analysis.
Overall sensitivity, specificity, accuracy, and positive and negative predictive (NPV) values for TBNA were 68%, 100%, 68.8%, 100%, and 10%, respectively. The most sensitive and accurate TBNAs were obtained for patients with small cell lung carcinoma and the worst results were for patients with lymphomas. NPV were similar for all pathologies. The most predictive factors of outcome were adenopathy size and the presence of indirect signs at the puncture site.
The sensitivity and accuracy of TBNA are high in small cell lung cancer, followed by other types of carcinoma, sarcoidosis, and tuberculosis, and low for lymphoproliferative diseases. The NPV of TBNA for all individual pathologies is low. The size of the adenopathy and the presence of indirect signs at the puncture site predict the achievement of diagnostic samples.