DIAGNOSTIC UTILITY OF BRONCHOSCOPY IN BRONCHOSCOPICALLY NONVISIBLE (PERIBRONCHIAL) TUMORS INCLUDING TBNA: STUDY OF 150 CASES IN TERTIARY CARE SETTING IN INDIA

Sanjay Mundkar and Patil Shital*

ABSTRACT

Background: Lung cancer is the leading cause of cancer deaths around the world. Globally, lung cancer is the largest contributor to new cancer diagnosis and to death from cancer. Various conventional diagnostic techniques (CDTs) such as endobronchial forcep biopsy (FB), bronchial washing (BW) and bronchial brushing (BB), and transbronchial needle aspiration cytology (TBNA) are employed during fiber-optic bronchoscopy. Methods: Prospective, two tertiary care center study conducted between November 2012 and February 2014 at Bronchoscopy unit of MIMSR Medical College Latur, & Venkatesh chest hospital Latur India, to find the role of TBNA in bronchoscopically nonvisible (peribronchial) lesions (PBL) in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BB, BW and FB, and included 150 patients on the basis of clinical and radiological features of malignancy. In Peribronchial lesions during bronchoscopy documented findings are narrowing of airway due to extrinsic compression by tumour or Lymphadenopathy, or predominant feature of ‘bulge’ seen in the lumen. TBNA, FB, BB and BW were performed in all the cases during FOB. Histopathological and cytological examinations of specimens were performed at Pathology department. The statistical analysis was done using chi square test. Results: Total 150 patients, on the basis of clinical and radiological signs of malignancy, between age group 21-87 years with mean age 59.16 years. Males were 81.33% of total, of which 79% were smoker with 57.87% cases were having >40 pack years smoking history. Commoner symptoms were cough (92.33%), Shortness of breath (66.33%) & chest pain (61.33%), while commoner radiological presenting features were hilar mass (51%), parahilar opacity (21%), collapse segmental/lobar (18%). In PBL, diagnostic yield of TBNA, FB & CDTs were 68.66% & 27.33% & 41.33% respectively. Additional CDTs like BB cytology and BW has additive yield to FB from 27.33% to 41.33% in PBL (P<0.00001). Sensitivity of TBNA in PBL is 96.19% while that of CDTs is 59 (P<0.00001). IHC on TBNA specimens had increased histological type confirmation. Conclusion: Transbronchial needle aspiration is a beneficial, safe and minimally invasive bronchoscopic technique with insignificant side effect in the diagnosis bronchogenic carcinoma. TBNA in peribronchial lesions is most sensitive modality over conventional techniques and considered as ‘gold standard’ in these lesions. TBNA will definitely decrease need for repeat bronchoscopy.

Keywords: TBNA, Bronchoscopy, peribronchial lesions (PBL), Lung cancer.