L'agoaspirato transbronchiale nella diagnosi delle neoplasie delle vie aeree centrali e delle lesioni polmonari periferiche

Introduction. Transbronchial needle aspiration was first described by Schieppati in 1949 and demonstrated to be a safe and useful diagnostic technique in sampling mediastinal adenopathies and in the staging of bronchial carcinoma. The good results achieved in staging pulmonary malignancies, have induced some Authors to employ this technique in the diagnosis of central bronchogenic carcinoma and of peripheral parenchimal lesions. Materials and methods. We made a systematic review of the literature, including trials involving at least 20 patients and evaluating the efficacy of both needle aspiration in sampling endobronchial neoplasm and peripheral pulmonary nodules and masses. Results. In 17 trials endobronchial needle aspiration (EBNA) showed a sensitivity of 68.3% and was the only diagnostic procedure in 17.6% of cases. This technique showed to be mainly useful in submucosal and peribronchial growth neoplasm, easily bleeding and necrosis covered malignancies. In 12 studies, transbronchial needle aspiration of peripheral lesions showed a sensitivity of 52.2% and was the only diagnostic procedure in 19.5% of patients. The efficacy of this technique is affected by the nature of the abnormality, the size of the lesion, the anatomical relation between the nodules and the airways and by the cytological on site evaluation. Discussion and conclusions. In both considered scenarios, transbronchial needle aspiration associated with forceps biopsy, brushing and bronchial washing (defined as conventional diagnostic methods), demonstrated to significantly increase the diagnostic efficacy of bronchoscopy, without augmenting the number of complications.