Background:
The number of Solitary pulmonary nodules are growing. In small lesions robotic and navigated procedures using virtual pathway are in use. A second procedure for the staging of the mediastinum is therefor needed. The question was, can the virtual support also used to improve the results of a navigated transbronchial needle aspiration (Navi-TBNA)
 
Methods:
Patients with enlarged, PET positive lymph nodes were included. The LungPoint® system (Bronchus Medical, USA) produced a virtual bronchoscopic (VB) pathway indicating the point for the TBNA in the. Central airway. VB images were displayed alongside and registered with actual bronchoscopic view. After reaching the point for puncture a classical 21 g TBNA were inserted and the cytological material. Endoscopically non-diagnostic samples led to mediastinoscopy or a 6-month-follow-up
 
Results:
133 lymph node samples from a total of 122 patients (age 59±12 years, male/female n=43/90) were included. Navi TBNA EBUS showed an overall diagnostic yield of 82.0% (definite diagnosis). The sensitivity was 0,85 and specificity 1,0. The most frequent locations included the mediastinal positions 4R (40.6%), 7 (31.6%) and 4L (13.5%). Differences between patients with diagnostic and non-diagnostic samples were neither found for lymph node size (16.9±5.2 vs. 14.5±5.4 mm, p=0.62) nor lymph node position (p=0.26, table 1).
No clinically significant procedure-related complications were encountered.
 
Conclusions:
This study demonstrates that Navi-TBNA is a safe procedure and provides diagnostic histological specimens of mediastinal lymph nodes in a large percentage of cases.