Conventional transbronchial needle aspiration cytology as a diagnostic tool in patients with suspected lung cancer - Our experience at a tertiary care center.

  • Dr. Rashmi Chauhan Assistant Professor, Department of Pathology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India
  • Dr. Seema Awasthi Professor and Head, Department of Pathology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India
  • Dr. Deepti Arora Associate Professor, Department of Pathology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India
  • Dr. Faiyaz Ahmed Professor, Department of Pathology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India
  • Dr. Himanshu Joshi Associate Professor, Department of Pathology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India
  • Dr. Ina Garg Post-Graduate, Department of Pathology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, India
Keywords: Bronchoscopy, Lung cancer, Transbronchial needle aspiration


Background: Conventional transbronchial needle aspiration (c-TBNA) is a minimally invasive bronchoscopic technique used to obtain cytological samples from peribronchial lesions and mediastinal lymph nodes. However, the concern about its efficacy and the advent of newer techniques have led to the underutilization of this time tested and cost-effective modality.

Objective: The present study was aimed to assess the diagnostic yield of c-TBNA in suspected cases of lung cancer.

Method: c-TBNA smears received from January 2017 to February 2020, with clinical-radiological suspicion of lung malignancy were retrospectively analyzed.

Result: A total of 22 cases were reviewed. The mean age of the study population was 57.54 years, with a male-female ratio of ~2:1. The adequate aspirate was obtained in 19/22 (86%) cases. The overall diagnostic yield of c-TBNA was 82%. 14/19 (74%) cases were positive for malignancy, non-small cell lung carcinoma being the most common malignancy diagnosed (11 cases). 4/19 (21%) cases were diagnosed with granulomatous pathology, while smears in 1 case were non-diagnostic.

Conclusion: Conventional transbronchial needle aspiration cytology is an efficacious method used for the diagnosis of lung carcinoma. Especially in resource-limited settings, it remains irreplaceable as a diagnostic tool and should be routinely utilized.


Download data is not yet available.


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: 10.3322/caac.21492.

Dar M, Sharma K. Burden of cancer in India: GLOBOCAN 2018 Estimates. Incidence, Mortality, prevalence and future projections of cancer in India. J Emerg Technol Innovat Res. 2019;6(6):505-514.

Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Transl Lung Cancer Res. 2015;4(4):327-338. doi: 10.3978/j.issn.2218-6751.2015.08.04.

Figueiredo VR, Jacomelli M, Rodrigues AJ, Canzian M, Cardoso PF, Jatene FB. Current status and clinical applicability of endobronchial ultrasound-guided transbronchial needle aspiration. J Bras Pneumol. 2013;39(2):226-237. doi: 10.1590/s1806-37132013000200015.

Prakash UB, Offord KP, Stubbs SE. Bronchoscopy in North America: the ACCP survey. Chest. 1991;100(6):1668-1675. doi: 10.1378/chest.100.6.1668.

Stanley JH, Fish GD, Andriole JG, et al. Lung lesions: cytologic diagnosis by fine-needle biopsy. Radiology. 1987;162(2):389-391. doi: 10.1148/radiology.162.2.3797651.

Delgado PI, Jorda M, Ganjei-Azar P. Small cell carcinoma versus other lung malignancies: diagnosis by fine-needle aspiration cytology. Cancer. 2000;90(5):279-285.

Bilaceroglu S, Chhajed P. Transbronchial needle aspiration: A diagnostic tool in routine bronchoscopy. J Assoc Physicians India. 2005;53:797‑802.

Herth FJ, Rabe KF, Gasparini S, Annema JT. Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions. Eur Respir J. 2006;28(6):1264-1275. doi: 10.1183/09031936.00013806.

Schieppati E. La puncion mediastinal a traves del espolon traqueal. [Trans-tracheal aspiration of the mediastinum]. Rev As Med Argent. 1949;663:497-499.

Wang KP, Terry PB. Transbronchial needle aspiration in the diagnosis and staging of bronchogenic carcinoma. Am Rev Respir Dis. 1983;127(3):344–347. doi: 10.1164/arrd.1983.127.3.344.

Liu QH, Ben SQ, Xia Y, Wang KP, Huang HD. Evolution of transbronchial needle aspiration technique. J Thorac Dis. 2015;7(S4):S224-S230. doi: 10.3978/j.issn.2072-1439.2015.11.31.

Yang H, Zhang Y, Wang KP, Ma Y. Transbronchial needle aspiration: development history, current status and future perspective. J Thorac Dis. 2015;7(S4):S279-S286. doi: 10.3978/j.issn.2072-1439.2015.11.36.

Dasgupta A, Mehta AC. Transbronchial needle aspiration. An underused diagnostic technique. Clin Chest Med. 1999;20(1):39-51. doi: 10.1016/s0272-5231(05)70125-8.

Cetinkaya E, Yildiz P, Altin S, Yilmaz V. Diagnostic value of transbronchial needle aspiration by Wang 22-gauge cytology needle in intrathoracic lymphadenopathy. Chest. 2004;125(2):527-531. doi: 10.1378/chest.125.2.527.

Ramieri MT, Marandino F, Visca P, Salvitti T, Gallo E, Casini B, et al. Usefulness of conventional transbronchial needle aspiration in the diagnosis, staging and molecular characterization of pulmonary neoplasias by thin-prep based cytology: experience of a single oncological institute. J Thorac Dis. 2016;8(8):2128-2137. doi: 10.21037/jtd.2016.07.62.

Bonifazi M, Tramacere I, Zuccatosta L, Mei F, Sediari M, Paonessa MC, et al. Conventional versus Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Hilar/Mediastinal Lymph Adenopathies: A Randomized Controlled Trial. Respiration. 2017;94(2):216-223. doi: 10.1159/000475843.

Küpeli E, Seyfettin P, Tepeoğlu MD. Conventional transbronchial needle aspiration: From acquisition to precision. Ann Thorac Med. 2015;10(1):50-54. doi: 10.4103/1817-1737.146873.

Walia R, Madan K, Mohan A, Jain D, Hadda V, Khilnani GC, et al. Diagnostic utility of conventional transbronchial needle aspiration without rapid on-site evaluation in patients with lung cancer. Lung India. 2014;31(3):208-211. doi: 10.4103/0970-2113.135754.

Darjani HR, Kiani A, Bakhtiar M, Sheikhi N. Diagnostic Yield of Transbronchial Needle Aspiration (TBNA) for Cases with Intra-Thoracic Lymphadenopathies. Tanaffos. 2011;10(4):43-48.

Farrag MA, El Assal GM, Madkour AM, Osman NM, Taha MH. Implementation of bronchoscopic conventional transbronchial needle aspiration service in a tertiary care chest hospital. Egypt J Bronchol. 2019;13(3):309-313. doi: 10.4103/ejb.ejb_95_18.

Tutar N, Büyükoğlan H, Yılmaz İ, Kanbay A, Önal Ö, Bilgin M, et al. Learning curve of conventional transbronchial needle aspiration. Clin Respiratory J. 2014;8(1):79-85. doi: 10.1111/crj.12041.

Madan NK, Madan K, Jain D, Walia R, Mohan A, Hadda V, et al. Utility of conventional transbronchial needle aspiration with rapid on-site evaluation (c-TBNA-ROSE) at a tertiary care center with endobronchial ultrasound (EBUS) facility. J Cytol. 2016;33(1):22-26. doi: 10.4103/0970-9371.175493.

Shah UC, Baby UR, Shah AC, et al. Conventional TBNA with 19 G TBNA needle in diagnosis of mediastinal lymph nodes – diagnostic yield and safety with 19G TBNA needle. Int J Contemp Med Res. 2020;7(2):B13-B16. doi: 10.21276/ijcmr.2020.7.2.49.

Soja J, Szlubowski A, Wasowski D, Kuzdzal J, Zieliński M, Sładek K. Transbronchial needle aspiration as a diagnostic method of mediastinal adenopathy. Przegl Lek. 2005;62(2):102-104.

Chokhani R. Transbronchial needle aspiration in the diagnosis of respiratory diseases. Nepal Med Coll J. 2004;6(1):24-27.

Khan A, Agarwal R, Aggarwal AN, Gupta N, Bal A, Singh N, et al. Blind transbronchial needle aspiration without an on-site cytopathologist: experience of 473 procedures. Natl Med J India. 2011;24(3):136-139.

Kumari A, Gupta M, Abhesheik. Diagnostic yield of TBNA and bronchial biopsy in lung cancer. Int J Res Med Sci. 2017;5(8):3708-3712. doi: 10.18203/2320-6012.ijrms20173590.

Holty JE, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: A meta-analysis. Thorax. 2005;60(11):949-955. doi: 10.1136/thx.2005.041525.

Punamiya V, Mehta A, Chhajed P. Bronchoscopic needle aspiration in the diagnosis of mediastinal lymphadenopathy and staging of lung cancer. J Cancer Res Ther. 2010;6(2):134-141. doi: 10.4103/0973-1482.65231.

Chin R Jr, McCain TW, Lucia MA, Cappellari JO, Adair NE, Lovato JF, et al. Transbronchial needle aspiration in diagnosing and staging lung cancer: How many aspirates are needed? Am J Respir Crit Care Med. 2002;166(3):377-381. doi: 10.1164/rccm.2106153.

Harrow EM, Abi-Saleh W, Blum J, Harkin T, Gasparini S, Addrizzo-Harris DJ, et al. The utility of transbronchial needle aspiration in the staging of bronchogenic carcinoma. Am J Respir Crit Care Med. 2000;161(2 Pt 1):601–607. doi: 10.1164/ajrccm.161.2.9902040.

Schenk DA, Chambers SL, Derdak S, Komadina KH, Pickard JS, Strollo PJ, et al. Comparison of the Wang 19‑gauge and 22‑gauge needles in the mediastinal staging of lung cancer. Am Rev Respir Dis. 1993;147(5):1251-1258. doi: 10.1164/ajrccm/147.5.1251.

Mehta AC, Wang KP. Teaching conventional transbronchial needle aspiration. A continuum. Ann Am Thorac Soc. 2013;10(6):685-689. doi: 10.1513/AnnalsATS.201308-272ED.

Kupeli E, Memis L, Ozdemirel TS, Ulubay G, Akcay S, Eyuboglu FO. Transbronchial needle aspiration “by the books”. Ann Thorac Med. 2011;6(2):85-90. doi: 10.4103/1817-1737.78427.

Baram D, Garcia RB, Richman PS. Impact of rapid on‑site cytologic evaluation during transbronchial needle aspiration. Chest. 2005;128(2):869‑875. doi: 10.1378/chest.128.2.869.

Diette GB, White P Jr, Terry P, Jenckes M, Rosenthal D, Rubin HR. Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. Chest. 2000;117(4):1186-1190. doi: 10.1378/chest.117.4.1186.

Trisolini R, Cancellieri A, Tinelli C, Paioli D, Scudeller L, Casadei GP,et al. Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy: a randomized trial. Chest. 2011;139(2):395-401. doi: 10.1378/chest.10-1521.

Herth F, Hecker E, Hoffmann H, Becker HD. Endobronchial ultrasound for local tumour and lymph node staging in patients with centrally growing lung cancer. Ultraschall Med. 2002;23(4):251-255. doi: 10.1055/s-2002-34056.

Herth F, Becker HD, Ernst A. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial. Chest. 2004;125(1):322-325. doi: 10.1378/chest.125.1.322.

Naruke T, Tsuchiya R, Kondo H, Nakayama H, Asamura H. Lymph node sampling in lung cancer: How should it be done? Eur J Cardiothorac Surg. 1999;16:S17-24. doi:10.1016/s1010-7940(99)00178-5.

Afrose R, Akram M, Karimi AM, Siddiqui SA . Correlation of age and gender with different histological subtypes of primary lung cancer. Med J DY Patil Univ. 2015;8:447-451.

Cancellieri A, Leslie KO, Tinelli C, Patelli M, Trisolini R. Sarcoidal granulomas in cytological specimens from intrathoracic adenopathy: morphologic characteristics and radiographic correlations. Respiration. 2013;85(3):244-251. doi: 10.1159/000345386.

Çetinkaya E, Yıldız P, Kadakal F, Tekin A, Soysal F, Elibol S, et al. Transbronchial needle aspiration in the diagnosis of intrathoracic lymphadenopathy. Respiration. 2002;69(4):335-338. doi: 10.1159/000063275.

DOI: 10.17511/jopm.2020.i07.01
Published: 2020-10-07
How to Cite
Dr. Rashmi Chauhan, Dr. Seema Awasthi, Dr. Deepti Arora, Dr. Faiyaz Ahmed, Dr. Himanshu Joshi, & Dr. Ina Garg. (2020). Conventional transbronchial needle aspiration cytology as a diagnostic tool in patients with suspected lung cancer - Our experience at a tertiary care center. Tropical Journal of Pathology and Microbiology, 6(7), 417-424.
Original Article