作者: Asok Dasgupta , Atul C. Mehta
DOI: 10.1016/S0272-5231(05)70125-8
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摘要: Despite its proven usefulness, TBNA is not widely used. An American College of Chest Physicians (ACCP) survey showed that only 11.8% pulmonologists use TBNA. Most in the 1980s were formally trained This lack training has unfortunately translated to minimal emphasis on current programs a large number institutions. Technical problems with procedure (faulty site selection, incomplete needle penetration, catheter kinking prevents adequate suction, etc.), confusing array needles, low diagnostic yields, unproven concerns regarding safety procedure, inadequate cytopathology support, and bronchoscopic damage have all perpetuated image limited usefulness for this procedure. Limitations practice are: Lack during fellowship inadequacies cytopathologists interpretation Fear bronchoscope Safety issues Failure reproduce published successes Reservations results Hands-on experience TBNA, developing familiarity expertise few paying careful attention anatomy, techniques, specimen acquisition may help increase yield. The following lists how better can be obtained TBNA: Preprocedure Review instruction tapes Attend hands-on courses Practice lung models patient's CAT scans Familiarize one-two cytology histology Obtain assistant Procedural Identify target Needle airway angle at least greater than 45 degrees Insert entire length Use scope channel support Release suction before withdrawing (for staging) Specimen Avoid delay preparing slides Adequate sampling (at two) smear method Analyze samples flush solutions cell block Postprocedure Find an experienced cytopathologist your (by watching video) pathology Acquisition skills needles should precede needle. Increasing education also yields. Transbronchial aspiration been accurate staging cancers, identifying inoperable carcinomas, diagnosing variety diseases. Few complications encountered technique less invasive costly surgical procedures. Drawing evidence from literature, we suggest guidelines All patients presenting mediastinal or hilar adenopathy both, 22-ga and/or 19-ga as initial These procedures would diagnose malignant nonmalignant diseases, stage cancers. submucosal peribronchial disease sampling. In visible endobronchial disease, optional. presence necrotic hemorrhagic tumor, patient bleeding diathesis, helpful. Type III IV peripheral nodules, There remains no doubt about Guidelines must developed ensure pulmonary fellows are adequately Regional workshops targeted practicing organized by ACCP popularize Initial yields discourage using Collaboration between thoracic surgeons, oncologists, physicians essential set up within With time, more attain full potential nonsurgical, cost-effective, safe will realized.