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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 103-104

COVID-19 pandemic and conventional transbronchial needle aspiration in the developing world


1 Department of Respiratory Medicine and Intervention Pulmonology, Venkateshwar Hospital, New Delhi, India
2 Department of Pathology, Venkateshwar Hospital, New Delhi, India

Date of Submission19-Feb-2021
Date of Decision24-Feb-2021
Date of Acceptance02-Mar-2021
Date of Web Publication18-Apr-2021

Correspondence Address:
Dr. Pratibha Gogia
Department of Respiratory Medicine and Intervention Pulmonology, Venkateshwar Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmrp.cmrp_26_21

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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



Dear Editor,

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.[1],[2]

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].
Table 1: Patient profile, procedure details and final diagnosis

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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.[3],[4] In that respect, C-TBNA can increase the cost-effectiveness of diagnostic bronchoscopy in the developing world.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mehta AC, Wang KP. Teaching conventional transbronchial needle aspiration. A continuum. Ann Am Thorac Soc 2013;10:685-9.  Back to cited text no. 1
    
2.
Balamugesh T, Herth FJ. Endobronchial ultrasound: A new innovation in bronchoscopy. Lung India 2009;26:17-21.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Herth F, Becker HD, Ernst A. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: A randomized trial. Chest 2004;125:322-5.  Back to cited text no. 3
    
4.
Phua GC, Rhee KJ, Koh M, Loo CM, Lee P. A strategy to improve the yield of transbronchial needle aspiration. Surg Endosc 2010;24:2105-9.  Back to cited text no. 4
    
5.
Sehgal IS, Dhooria S, Gupta N, Bal A, Ram B, Aggarwal AN, et al. Impact of endobronchial ultrasound (EBUS) training on the diagnostic yield of conventional transbronchial needle aspiration for lymph node stations 4R and 7. PLoS One 2016;11:e0153793.  Back to cited text no. 5
    



 
 
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