Low cost for high diagnostic yield: a cohort of 435 patients who underwent transtracheal or transbronchial needle aspiration with Schieppati rigid needle.

MA. Saab*^a (Dr), A. Branda^a (Dr), A. Ortiz Nareto^a (Dr), I. Martin^a (Dr), MC. La Piettra^a (Dr), A. Briozzo^a (Dr), S. Gando^a (Dr), P. Simkin^a (Dr), D. Violi^a (Dr), B. Vazquez^a (Dr), M. Korsunsky^a (Mr), G. Martinez^a (Dr), A. Sansostera^a (Dr), R. Dure^a (Dr)

^a Hospital F.J. Muñiz, Buenos Aires, ARGENTINA

* marilasaab@gmail.com

Background:

Transtracheal sampling of mediastinal structures using a reusable rigid aspirative needle (RAN) through rigid bronchoscopy (RB) was described in 1949 by Eduardo Schieppati to diagnose lesions adjacent to central airways (CA). Although this technique has been gradually replaced by newer technologies in high income countries, it remains an affordable tool in many developing economies.

Methods:

In a retrospective cohort, procedures using RAN (May 2010 to December 2021) were reviewed. Patient data were collected from our internal database and cross-checked with cytological tests results. It included adults with enlarged mediastinal nodes or pulmonary lesions over 2 cm accesible via CA. Specimen collection using RAN was conducted by interventional pulmonologists trained in RB in patients under conscious sedation and spontaneous ventilation, with a minimum of 3 samples collected per procedure.

Results:

Of the 435 patients whose data were analyzed, 70,1% were men with a median age of 58. Most (55,4%) were referred to obtain diagnosis of a mediastinal lymphadenopathy or mass, followed by a 33,6% with a pulmonary mass under study or a combination of both lesions (6,2%).

A representative sample was obtained in 84,6% of procedures and the overall diagnostic yield was 79,8%, being lung cancer infiltration the most common (44,4%) finding. Other diagnoses included nodal tuberculosis (12,4%), infiltration by another cancer (9,7%), sarcoidosis (2,5%) and other infections (2,3%). No correlation was found between the absence of airway alterations during bronchoscopy (43,9%) and a lesser chance of achieving nodal disease diagnosis or a good quality sample.

Only 8,8% of patients registered mild procedure-related complications (transient desaturation and self limited bleeding).

Conclusion:

Sample collection via RAN in trained hands is a safe and cost-effective method to diagnose mediastinal or central pulmonary lesions when disposable aspiration needles or ultrasound guided technologies are not available.

Disclosure of funding source(s): none