Diagnostic value and learning curve of transbronchial needle aspiration in thoracic surgery.

AIM: Transbronchial needle aspiration (TBNA) is particularly indicated in diagnosing mediastinal masses or lymphoadenopathy proximal to the airways. Nowadays TBNA has not been widely accepted among pulmonologist and thoracic surgeons. Since its correct management could reduce patient morbidity we adopted this method. Here is presented an overview of our experience over a 18-months training period. METHODS: Fifty patients underwent TBNA. They presented non diagnosed paratracheal or peribronchial lymphadenopathy or masses of >1 cm. TBNA has been considered in order to spare patients the need for more invasive diagnostic procedures. TBNA has been performed with flexible bronchoscope and 19-gauge or 21-gauge needle. RESULTS: We made diagnosis of disease in 25 of 41 patients whose adequate sampling was obtained. 16 cases showed absence of disease despite criteria for adequacy have been confirmed, 9 cases presented an inadequate specimen. The overall diagnostic yield and sensitivity were 50% and 86%. The overall accuracy was 76%. Considering the last 6 months of the training period diagnostic yield increased from 18.7% to 88.2% (P<0.001),accuracy from 56.2% to 88.2% (P=0.04) and frequency of inadequacy decreased from 43.7% to 11.7% (P=0.046). CONCLUSIONS: TBNA resulted a successful diagnostic tool in selected cases as it is safe and permits to spare patients the need for more invasive procedures. These data revealed that experience is mandatory in order to achieve acceptable RESULTS: We think that an experienced operator should require a training period of approximately 50 procedures to obtain a good technique proficiency.

Radiofrequency ablation of pulmonary lesions.

PURPOSE: Radiofrequency ablation uses the thermal energy produced by a generator to create a coagulative necrosis. The method is well established for the treatment of a variety of primary and secondary cancers of the liver but is less well studied for the treatment of lung malignancies. MATERIALS AND METHODS: From March 2005 to March 2006, 11 patients (seven men and four women) with single or multiple pulmonary nodules underwent radiofrequency ablation of 12 unresectable pulmonary tumours. Follow-up computed tomography (CT) was performed at 1, 3, 6, and 12 months after radiofrequency ablation. Lesions were evaluated for dimensions and contrast enhancement. RESULTS: Radiofrequency ablation was well tolerated by all patients. Postprocedural complications included four cases of pneumothorax treated with simple aspiration without tube placement and one case of small parenchymal haemorrhage. There were no major complications. CONCLUSIONS: Radiofrequency ablation of primary or secondary pulmonary lesions is a safe and technically feasible option for the management of unresectable pulmonary malignancies.