Cost effectiveness of transbronchial needle aspiration.

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy. DESIGN: Retrospective study. SETTING: A university hospital. POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy. RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented. CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

Fibreoptic bronchoscopy in the diagnosis of pulmonary disease in the immunocompromised host in northern Alberta.

OBJECTIVES: To determine the diagnostic utility of bronchoscopy in a population of immunocompromised hosts in northern Alberta. PATIENTS AND METHODS: Results from bronchoscopy in 86 immunocompromised patients who underwent a total of 101 procedures were retrospectively reviewed. RESULTS: The overall diagnostic yield was 57% with the highest yield in patients on immunosuppressive drug therapy (80%) and the lowest yield in the group of bone marrow transplant patients (27%). CONCLUSIONS: Bronchoscopy is a valuable tool for the evaluation of pulmonary disease in the immunocompromised host. Overall diagnostic yield of 57% is comparable with that reported in the literature.

The value of submucous needle aspiration in the prediction of surgical resection line of bronchogenic carcinoma.

The fiberoptic bronchoscope was used to perform a series of SMNAs from the tumor site in the bronchial tree toward the carina to decide on an appropriate surgical line of resection in 20 patients. The line of resection was examined histologically for tumor invasion. Of the 20 patients who underwent surgery 16 had lobectomies and four had pneumonectomies. Eighteen patients had no evidence of tumor invasion at the surgical resection site. Of the remaining two, one had a cancer-positive SMNA proximal to the resection line and demonstrated tumor cells in the surgical resection line. The second demonstrated tumor cells in the right lower and upper lobes with sparing of the right bronchus intermedius. This patient underwent lobectomy with subsequent resection of the remaining right upper lobe. On the basis of this experience we conclude that SMNA is effective in predicting the optimal surgical line of resection in lung carcinoma.