Conventional TBNA with 19 G TBNA Needle in Diagnosis of Mediastinal Lymph Nodes – Diagnostic Yield and Safety with 19G TBNA Needle

Introdution: As the practice of TBNA becomes more widelyaccepted, it has also revived a longstanding question on theoptimum size of needle and whether larger needle with corebiopsy is of any additional benefit. In routine practice 19Gneedle is rarely used even in large nodes as it is perceivedto be technically difficult and likely to give a poor yield ofrepresentative tissue. We report our experience with yield andsafety using 19G needle for Conventional TBNA.Material and methods: Eighteen patients with largemediastinal nodes (short axis > 25 mm) underwent 19GConventional TBNA and station 4R and/or stations 7 werepunctured respectively.Results: Out of Eighteen patients, core biopsy material wasinadequate or unrepresentative in 14 / 18 cases and cytologymaterial was unrepresentative in 2 patients. A diagnosiswas reached in 16 of 18 patients by smear cytology and in14 cases by histology. Out of eighteen patients, 12 patientshad Granulomatous etiology, 2 had poorly differentiatedadenocarcinoma, 1 had Malignant Round Cell Tumor, and onepatient had reactive lymphadenitis.Conclusion: The 19G TBNA procedure is effective and safe,and can be a cost-saving alternative to surgical mediastinalexploration. It should be performed after careful case selectionduring initial diagnostic bronchoscopy and familiarizationwith the technique should not be neglected in trainingprogrammes and workshops.

Bronchoscopic Analysis in Sputum Smear Negative Pulmonary Tuberculosis Patients A Hospital based Study

Introduction: India has the highest burden of TB cases inthe world, majority of them are pulmonary tuberculosis.The method of choice for diagnosis of PTB is microscopicexamination of AFB by sputum smear. However, 30 to 50%of patients with pulmonary tuberculosis can have negativesputum report or may not produce sputum. Flexible fibreopticbronchoscopy can provide excellent material for diagnosis forpatients with suspected sputum smear negative pulmonarytuberculosis. Study aimed to evaluate the role of fiberoptic bronchoscopy in sputum smear negative pulmonorytuberculosis.Material and methods: Forty suspected cases of pulmonaryTB with clinical and radiological evidence of tb and sputumsmear negative on 2 occasions were selected for thisprospective nonrandomised observational study. Detailedexamination of the bronchial tree was done and specimensincluding bronchial aspirate and lavage was collected andsend for investigations. Post bronchoscopy sputum (PBS) wasalso collected and sent for smear microscopy.Results: In our study of 40 patients, tuberculosis wasconfirmed in 13 (32.50%) by smear examination of AFB inBroncho alveolar fluid and by post bronchoscopy sputumsmear examination in 3/40 (7.5%) cases. A definitive diagnosisof tuberculosis was possible in 23 (57.5%) of the 40 patientsby AFB culture by BACTEC MGIT960.Conclusion: Fibreoptic bronchoscopy with post bronchoscopysputum,BAL and BAL AFB culture is a useful tool fordiagnosis and can thereby prompt treatment of sputum smearnegative pulmonary tuberculosis patients.