The value of TBNA in diagnosis of thoracic diseases

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Fiberoptic bronchoscopy is a commonly used method for the diagnosis of respiratory diseases, which is fast, safe and economical. The develop

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Fiberoptic bronchoscopy is a commonly used method for the diagnosis of respiratory diseases, which is fast, safe and economical. The development of bronchoscopy has undergone three stages: traditional rigid bronchoscopy, fiberoptic bronchoscopy, modern electronic bronchoscopy, and rigid bronchoscopy. Transbronchial needle aspiration (TBNA) specimens carefully, less bleeding, more suitable for necrotic or submucosal lesions diagnosis; it is not necessary in the necrotic tissue surface or normal mucosa on repeated sampling, can go directly to the vitality of the organization, to obtain tracheal cavity disease tissue, improve the positive rate of.

1 TBNA technical requirements

Be familiar with the anatomy of the lung and mediastinum, and have a good three-dimensional imagination and positioning ability.

The operator should carry out practical training.

Familiar with the characteristics of various types of needle. The master position method and operation technology.

2 TBNA purpose and contraindications

2.1 purpose

Specimens obtained from the outside of the airway but close to the trachea and bronchial wall;

To obtain the pathological changes of the trachea and bronchus;

To obtain the pathological changes of hilar lesions;

The lesions were to obtain external tumor segmental bronchial compression;

The staging of lung cancer;

6 of mediastinal cyst or abscess drainage.

2.2 contraindications

The general condition is bad, the constitution frail cannot withstand the TBNA inspector.

The spirit is not normal, can not cooperate with the examination of patients.

Patients with severe chronic cardiovascular disease.

The chronic respiratory disease with severe respiratory insufficiency patients, if need to check, can be carried out in the oxygen, mechanical ventilation and ECG monitoring.

5 on narcotic drug allergy, can not be used to replace other drugs.

The serious bleeding disorder and coagulation mechanism.

The respiratory tract with acute suppurative inflammation, fever and hemoptysis is an acute asthmatic attack, can be in remission after.

3.TBNA common complications

The pneumothorax and mediastinal emphysema, a low incidence of less than 1%.

Bleeding phenomenon, but the amount of bleeding is generally small, often can stop.

Mediastinal infection, less chance of occurrence. Strict aseptic operation can avoid infection.

The incidence of arrhythmia or sudden death, less repeated history before operation, electrocardiogram examination, and prepare emergency medicine related.

4 TBNA steps

4.1 to define the anatomical part of the trachea and bronchus

1 before the carina lymph node; 2 carinal lymph nodes; 3 right paratracheal lymph nodes; 4 left paratracheal lymph nodes; 5 lymph nodes of 6 right main bronchus; left main bronchial lymph nodes; 7 right hilar lymph nodes; 8 subcarinal lymph nodes; 9 right hilar lymph nodes; 10 carina the distal lymph nodes; 11 left hilar lymph node

4.2 conventional location

The repeated reading chest CT, chest CT, according to the confirmation of the bronchial carina ridge, divided the aortic arch and other related structure, the puncture reference mark.

According to the distance of the CT layer, the distance between the focus and the mark point was calculated, and the angle and depth of the needle were determined according to the location of the lesion on CT.

According to the distance between the focus and the mark point and the angle of the needle, the puncture point and the direction of needle insertion were determined.

4.3 choose the right puncture needle

Commonly used puncture needles include:

N1C cytology needle, N2C tissue puncture needle (Olympus, Japan). The puncture needle below 8 mm is suitable for submucosal lesions, and more than 8 mm puncture needle is suitable for the external focus.

The SW-121 mm 21G 13 core needle, needle cytology (diameter 0.8 mm, diameter 0.6 mm); MW-122 mm 22G 15 core needle, needle cytology (diameter 0.7 mm, diameter 0.5 mm), easy to wear breathable wall; learn the needle MW-319:19G (diameter 1 mm, diameter 0.8 mm), not easy to wear breathable wall. Provided by the United States MILL-ROSE company.

4.4 puncture methods and techniques

The puncture method includes the method of needling, pushing, cough, metal ring close to the airway wall and so on.

Puncture technique:

Before and after the surgery, the chest CT film was repeated to determine the puncture site.

Puncture angle 45 degrees.

All the puncture needles were inserted into the trachea or bronchus wall.

The puncture needle in the lesion out of 8 ~ 10 times repeatedly.

The needle before the release of negative pressure.

4.5 specimen preparation

In order to obtain a higher positive rate, at least 2 specimens were obtained in the process of specimen preparation;

The specimen should be quickly fixed with anhydrous ethanol;

The puncture tissue was fixed with formaldehyde, and the washing fluid was also examined by cytology;

The inspection should be related to the pathology department after the close cooperation and communication, in order to increase the accuracy of the results.

4.6 puncture results evaluation

The results of TBNA were classified into three types: positive, suspicious and negative.

The positive results were related to the size of lymph nodes, the degree of abnormal bulge in the lumen, the pathological type of tumor and the location of lymph nodes.

There are few cases of false positive, and most of the pollution comes from the secretion of airway and mucosa.

The incidence of false negative is relatively high: the need for close cooperation with the pathologist and communication, repeated cytological examination.

 

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