TBNA

TBNA stands for transbronchial needle aspiration, a minimally invasive bronchoscopic procedure designed to sample tissue from structures adjacent to the airways, most commonly mediastinal and hilar lymph nodes and mass lesions. It is used to obtain cytologic or histologic material for diagnosis and staging of thoracic diseases, particularly lung cancer, as well as for sarcoidosis, granulomatous infections, and other mediastinal masses.

The procedure is performed during bronchoscopy. A needle is passed through the wall of the bronchus into the target lesion or node to aspirate or procure tissue. Conventional TBNA relies on anatomical landmarks and, in some cases, fluoroscopic guidance. A newer approach, EBUS-TBNA, uses endobronchial ultrasound to visualize targets in real time and can improve yield and safety. Rapid on-site evaluation (ROSE) of specimens by cytopathology is often used to assess adequacy.

Indications include evaluation of unexplained mediastinal or hilar lymphadenopathy, diagnosis of mediastinal masses, and staging of non-small cell lung cancer and certain other thoracic diseases. It can provide material for cytology and, with core needles, histology.

Complications are uncommon but can include bleeding, pneumothorax, infection, and transient hypoxemia. Contraindications include uncorrected coagulopathy, severe cardiovascular instability, or inability to tolerate bronchoscopy.

TBNA offers a minimally invasive alternative to surgical procedures such as mediastinoscopy. Its diagnostic yield varies with technology (cTBNA vs EBUS-TBNA), lesion location, and operator experience. It is often integrated into multimodal diagnostic and staging pathways for thoracic disease.