Clinics in chest medicine
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Clinics in chest medicine · Mar 1999
ReviewTransbronchial needle aspiration. An underused diagnostic technique.
Despite its proven usefulness, TBNA is not widely used. An American College of Chest Physicians (ACCP) survey showed that only 11.8% of pulmonologists use TBNA. Most pulmonologists in the 1980s were not formally trained in TBNA. ⋯ Initial low yields should not discourage pulmonologists from using the procedure. Collaboration between thoracic surgeons, oncologists, and pulmonary physicians is essential to set up TBNA programs within institutions. With time, as more and more pulmonologists attain expertise in TBNA, the full potential of this nonsurgical, cost-effective, and safe procedure will be realized.
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Since it was first used 70 years ago, brachytherapy has become an effective tool in the treatment with tracheal bronchial malignancy including primary and recurrent bronchogenic carcinoma and metastatic carcinoma. The technique has evolved from interstitial implantation of radioactive sources directly to the tumor using rigid bronchoscopy to intraluminal placement of a radioactive source into a polyethylene afterloading catheter placed using FB. Intraluminal brachytherapy is effective in palliating complications caused by malignant endobronchial tumors such as dyspnea, hemoptysis, intractable cough, atelectasis, and postobstructive pneumonia. ⋯ When tumor involves the mainstem bronchi and upper lobes, it seems prudent to obtain CT to exclude tumor invasion of the pulmonary arteries or considerable destruction of the bronchial wall and mediastinal invasion of the tumor. Patients with findings such as these should not be treated with endobronchial brachytherapy or treated with LDR brachytherapy. Brachytherapy is proved to be effective and a safe palliative treatment for endobronchial malignancies, but further investigations are necessary to determine the optimal dose scheme and its efficiency in bronchogenic carcinoma and combined with external beam radiation therapy or surgery or other endobronchial procedures such as Nd:YAG laser or cryotherapy.