|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 103-104
COVID-19 pandemic and conventional transbronchial needle aspiration in the developing world
Pratibha Gogia1, Renu Madan2, Tarun Bhatnagar1, Shruti Dogra2
1 Department of Respiratory Medicine and Intervention Pulmonology, Venkateshwar Hospital, New Delhi, India
2 Department of Pathology, Venkateshwar Hospital, New Delhi, India
|Date of Submission||19-Feb-2021|
|Date of Decision||24-Feb-2021|
|Date of Acceptance||02-Mar-2021|
|Date of Web Publication||18-Apr-2021|
Dr. Pratibha Gogia
Department of Respiratory Medicine and Intervention Pulmonology, Venkateshwar Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gogia P, Madan R, Bhatnagar T, Dogra S. COVID-19 pandemic and conventional transbronchial needle aspiration in the developing world. Curr Med Res Pract 2021;11:103-4
|How to cite this URL:|
Gogia P, Madan R, Bhatnagar T, Dogra S. COVID-19 pandemic and conventional transbronchial needle aspiration in the developing world. Curr Med Res Pract [serial online] 2021 [cited 2022 Jan 16];11:103-4. Available from: http://www.cmrpjournal.org/text.asp?2021/11/2/103/314027
Over the period of past 10 years, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has gained much popularity among Indian interventional pulmonologists. Unintentionally, the conventional TBNA (C-TBNA) is underutilised and the skill is fast fading.,
Incidentally, in the developing world, the practice and upkeep of EBUS-TBNA are extremely expensive. Besides, getting a prompt repair of a damaged EBUS scope is also challenging. Needless to say that, this delay is further compounded by the COVID-19 pandemic and the lockdown of the country. It is also realised that the luxury of a spare or a loaner scope is almost non-existent in India.
In our case, an EBUS scope went out for a repair on 12th March 2020 with an arrangement for a quick replacement. Unfortunately, due to the total national lockdown, it never happened. The scenario was similar to that before acquiring the EBUS scope. During the following 8 weeks, we encountered 14 cases with mediastinal masses and enlarged lymph nodes (LNs) who would have customarily undergone diagnostic or staging EBUS-TBNA. As delay in establishing the diagnosis was not an option, we chose to perform C-TBNA in selected cases (11) with LNs at stations 4R, 7, and 11 with short-axis diameter of 15 mm or greater. The procedure was performed by a single bronchoscopist (PG) with a 21-G Olympus needle (NA 601D-1519) (PG was trained with C-TBNA during her postgraduate training and senior residency [2001–2007] and had performed 30–50 cases per year. She had stopped performing the procedure since acquiring EBUS scope in 2016). Four to five passes were made at each station. No rapid-onsite examination was available. The material aspirated partly was spread into a thin smear on slides, and the rest was flushed with saline and collected in CytoLyt® solution. A part of the flushed material was sent for microbiological analysis Gene Xpert for Mycobacterium tuberculosis, acid fast bacilli culture and cytological examination.
14 patients with mediastinal lymphadenitis presented for EBUS FNAC from March 2020 to May 2020 but as EBUS scope was out for repair, three( 21.3%) patients were declined as lymph node size was small (< 15mm) and location was other than 4R/ Station 7/ 11R. A definite diagnosis could be established in all other 11 cases (98.7%) (100% of all attempted); 5 (46%) M. tuberculosis, 2 (18%) sarcoidosis, 2 (18%) malignancies (plasma cell tumour and adenocarcinoma) and 2 (18%) reactive LNs. In the latter two cases, the results were compatible with the clinical suspicion of benign condition. Material was adequate in all samples as commented by the pathologist [Table 1].
C-TBNA is still a very useful diagnostic tool, especially in the developing world with the high prevalence of M. tuberculosis. It can aid in timely diagnosis of various benign and malignant mediastinal pathologies, especially when the LNs are larger than 15 mm size and located at favourable stations in a very cost-effective manner without any expensive equipment and specialised training. All contemporary pulmonologists should essentially gather the skills. It has been previously shown that the yield of C-TBNA and EBUS-TBNA is equal for the station 7 and 4R when the size of LN is greater than 15 mm., In that respect, C-TBNA can increase the cost-effectiveness of diagnostic bronchoscopy in the developing world.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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