Clinical Case Studies: Flexible Bronchoscopy With Transbronchial Needle Aspiration Confirmed By Endobronchial Ultrasound
Chae Ban Striffolino RN
Tamara Moore BSN, RN
LeAnne Vitito MS, RN, CGRN, APRN; Department Editor

Gastroenterology Nursing
June 2011 
Volume 34  Number 3
Pages 243 - 244
  PDF Version Available!

Transbronchial needle aspiration (TBNA) is an established procedure for diagnosing and staging lung cancer with mediastinal adenopathy and lung masses (Turner & Wang, 2004). Recent development of endobronchial ultrasound (EBUS) TBNA has sparked greater interest to this procedure because the lesion can be visualized first and then biopsied under a live ultrasound image (Becker & Herth, 2004).When performing TBNA, the bronchoscopist must have a thorough knowledge of the endobronchial anatomy and its TBNA staging system. The International Association for the Study of Lung Cancer has updated a staging system for identifying the nodal stations. The stations are as follows: 4R represents the right paratrachea and the proximal right main bronchus area; 4L, the left paratracheal and the proximal left main bronchus area; station 7, the subcarinal area; 11R, the right hilar area; and 11L, the left hilar area. The nodal status is as follows: N1, there is involvement of the ipsilateral peribronchial and hilar lymph nodes; N2, there is involvement of the ipsilateral mediastinal and/or subcarinal lymph nodes; and N3, there is extension of tumor to the contralateral hilar or mediastinal lymph nodes (Wang & Browning, 2010).The following highlights two cases illustrating the knowledge of endobronchial anatomy and the staging system along with the application and principles of TBNA with or without ultrasound guidance.A patient was referred with a left lung mass and a medical history of a bladder tumor. The computed tomographic (CT) scan showed small lymph nodes at 4L, 4R, and 11L. EBUS-TBNA was performed transnasally. The first group of lymph node punctures was made with an MW 322 transbronchial needle at N3 (4R), N2 (4L), and N1 (11L) sequentially without the visualization of the ultrasound image. (Note: An MW 322 transbronchial needle is usually recommended for central lesions.) The puncture site of each station was selected according to the WANG TBNA staging system (Wang, Mehta, &

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