Conventional Transbronchial Needle Aspiration Decreases the Rate of Surgical Sampling of Intrathoracic Lymphadenopathy* Nina M. Patel, MD; Anne Pohlman, RN, MS; Aliya Husain, MD; Imre Noth, CMD; Jesse B. Hall, MD, FCCP; and John P. Kress, MD, FCCP Background: Previous studies have suggested a decreased need for the surgical biopsy of intrathoracic lymph nodes (LNs) due to improved diagnostic rates utilizing transbronchial needle aspiration (TBNA) with endobronchial ultrasound and endoscopic ultrasound. The goal of this study was to determine whether conventional TBNA using combined cytologic and histologic analysis of tissue specimens impacted the rates of surgical diagnostic biopsies of patients with intrathoracic lymphadenopathy. Methods: Retrospective review at a single academic center. All mediastinal and hilar tissue samples submitted for pathologic analysis over an 8.4-year period were analyzed. Patients were categorized into a “before” group and an “after” group based on two different time periods. The before group underwent only cytologic analysis of Wang needle (19-gauge or 21-gauge) aspirates. The after group had cytologic analysis of aspirates as well as histologic analysis of needle “core” (19 gauge) biopsy specimens. The groups were compared for the rate of intrathoracic LNs sampled by surgical means vs TBNA and the number of times that TBNA averted the need for a surgical diagnostic procedure. Results: The success of TBNA increased significantly in the after group compared to that in the before group. The yield for the successful sampling of mediastinal and hilar LNs increased from 53 to 91% (p < 0.001) in the before group vs the after group. TBNA averted a surgical biopsy in 35% of the before cases compared to 66% of the after cases (p < 0.001). Conclusions: Conventional TBNA using large-bore needles with both cytology and surgical pathology evaluation decreases the need for surgical sampling of the mediastinum to diagnose thoracic lymphadenopathy. (CHEST 2007; 131:773–778) Key words: core needle biopsy; endobronchial ultrasound; endoscopic ultrasound; mediastinoscopy; transbronchial needle aspiration Abbreviations: EBUS  endobronchial ultrasound; EUS  endoscopic ultrasound; LN  lymph node; PET  positron emission tomography; TBNA  transbronchial needle aspiration T he importance of transbronchial needle aspira- tion (TBNA) as a tool for diagnosing intratho- racic lymphadenopathy as well as in the staging of lung cancer has been validated in a number of studies. 1–4 To date, however, surgical procedures (eg, mediastinoscopy, mediastinotomy, thoracotomy, *From the Columbia University Medical Center (Dr. Patel), New York, NY; and The University of Chicago (Ms. Pohlman, and Drs. Husain, Noth, Hall, and Kress), Chicago, IL. The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Manuscript received May 31, 2006; revision accepted September 26, 2006. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal. org/misc/reprints.shtml). Correspondence to: Nina M. Patel, MD, Columbia University, Medicine, Division of Pulmonary & Critical Care, 622 W 168th St, PH 8 East, Room 840, New York, NY 10032; e-mail: np2199@columbia.edu DOI: 10.1378/chest.06-1377 Original Research INTERVENTIONAL PULMONOLOGY www.chestjournal.org CHEST / 131 / 3 / MARCH, 2007 773