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TRANSBRONCHIAL NEEDLE ASPIRATION IN HIV-INFECTED PATIENTS WITH INTRATHORACIC ADENOPATHY: A 15-YEAR EXPERIENCE AT A MAJOR TEACHING HOSPITAL

New York University/ Bellevue Hospital, New York, NY

PURPOSE: We reported our initial experience with transbronchial needle aspiration (TBNA) in the HIV-infected patient in 1998* and 1999**. This abstract reviews our 15-year experience in the use of transbronchial needle aspiration (TBNA) as the initial invasive diagnostic procedure in HIV-infected patients with intrathoracic adenopathy at Bellevue Hospital Center. *AJRCCM 1998;157:1913-1918. **Chest 1999;116:S257-258.

METHODS: A retrospective review of all bronchoscopies utilizing TBNA performed by the Bellevue Hospital Chest Service from 1991 to 2005 was conducted. Charts were reviewed for age, gender, radiographic findings, HIV status, histology, cytology and culture analysis. All diagnostic procedures in addition to bronchoscopy were also reviewed. All patients underwent a chest CT and, if HIV-infected, had at least 3 negative sputum smears for acid fast bacilli prior to bronchoscopy. TBNA was performed via flexible bronchosopy using either a 19g histology needle or a 21g cytology needle.

RESULTS: 479 procedures were performed, of which 152 were in HIV-infected cases. In this HIV-infected group, adequate lymph node specimens were obtained in 113/152 (74%) and diagnostic material was obtained in 80/152 (53%). TBNA was positive in 11/24 (46%) of neoplastic conditions with yields of 50% (6/12) in the non-small cell lung cancer subbgroup and 63% (5/8) in the lymphoma subgroup. In patients with benign and/or infectious conditions, TBNA was positive in 69/98 (70%), with a yield of 58/71 (82%) in mycobacterial disease (41 tuberculosis, 28 non-tuberculous mycobacteria and 2 mixed) and 6/8 (75%) in fungal disease. Overall, TBNA provided the only diagnostic specimen in 53/152 (35%) of cases.

CONCLUSION: We conclude that TBNA is useful and provides a high diagnostic yield in patients with HIV-related intrathoracic adenopathy in a teaching hospital setting.

CLINICAL IMPLICATIONS: TBNA should be used as the initial invasive diagnostic procedure in patients with HIV-related intrathoracic adenopathy.

DISCLOSURE: Pablo Herscovici, None.