Lecture Notes on Bronchoscopy and Lymph Node Biopsy

Patient Case Overview

• Patient: 32-year-old woman
• Presenting Issues:
  • Mediastinal adenopathy (enlarged lymph nodes)
  • Progressive shortness of breath
• Concerns:
  • Possible malignancies (e.g., lymphoma)
  • Sarcoidosis (Stage one with mediastinal adenopathy)
  • Rule out infections

Diagnostic Process

• Initial Evaluation:
  • Importance of bronchoscopy for diagnosis
  • Check for mucosal thickening (could indicate sarcoidosis)
• Differential Diagnosis:
  • Malignancies (especially in young women)
  • Lymphoma
  • Other mediastinal tumors
  • Infections

Bronchoscopy Procedure

• Goals:
  • Sample lymph nodes (major pathology)
  • Use transbronchial needle aspiration (TBNA) as the least invasive method

Equipment Used

• Needle Type:
  • 21-gauge TBNA needle
  • Syringe and needle catheter device

Procedure Steps

1. Preparation:

   • Open the package, check needle tip
   • Ergonomics for easy handling

2. Approaching Lymph Nodes:

   • Focus on right hilum and surrounding areas
   • Adjust as needed for optimal access

3. Needle Insertion:

   • Anchor the needle into the mucosa
   • Perform aspiration without suction for initial samples
   • Monitor for hemorrhage (minimal is ideal)

4. Sample Collection:

   • Send specimens for cytology and infectious workup
   • Ensure no complications during procedure

Subsequent Techniques

• Core Biopsy:
  • Use a larger gauge needle (19-gauge) for more substantial samples
  • Similar steps as above but adjusted for needle size
• Results from First Pass:
  • Presence of bronchial cells, lymphocytes, granuloma-like cells
  • Indications of sarcoidosis or infection
  • Avoidance of more invasive median sternotomy procedures

Conclusion

• Benefits of TBNA:

  • Less invasive than traditional methods
  • Can obtain samples from both primary lung mass and central airway lymph nodes
  • Useful for staging in lung cancer cases

• Final Note:

  • TBNA provides an effective sampling mechanism in a single bronchoscopic procedure.