Transbronchial needle aspiration in the diagnosis of submucosal and peribronchial bronchogenic carcinoma.

Although exophytic endobronchial lesions can readily be diagnosed by routine forceps biopsy through the fiberoptic bronchoscope, submucosal or peribronchial tumor can be difficult to diagnose with nonsurgical techniques. We evaluated the utility of transbronchial needle aspiration (TBNA) through the fiberoptic bronchoscope in 31 patients presenting with endoscopic abnormalities suggestive of submucosal or peribronchial tumor. TBNA was performed using a 20 g X 1 cm needle, followed by forceps biopsy of the same area. Forceps biopsy was positive in 17 cases (55 percent) and TBNA in 22 (71 percent) (p = .302). The combination of forceps biopsy and TBNA was positive in 27 cases (89 percent), which was significantly better than forceps biopsy alone (p = .00195). In addition, the wash or the brush detected three additional carcinomas, so the combination of TBNA, forceps biopsy, wash, and brush had a diagnostic yield of 97 percent. We conclude that TBNA significantly increases the yield over forceps biopsy alone in the detection of submucosal or peribronchial bronchogenic carcinoma and that the maximal diagnostic yield is obtained by the combination of TBNA, forceps biopsy, wash, and brush when appropriate endoscopic abnormalities are encountered.