A comparative study of the Wang 21-gauge and 20-gauge needles for bronchoscopic use

Transbronchial needle aspiration (TBNA) enables one to diagnose carcinoma. The comparative diagnostic yields of the W-220 and SW-221 TBNA needles were evaluated inboth central and peripheral lesions, with malignant or benign diseases. We obtained 42 paired specimens with both needles from 20 consecutive patients referred for either diagnosis of pulmonary nodules/masses or for staging of bronchogenic carcinoma. Peripheral brush and/or forceps biopsy in conjunction with TBNA, and percutaneous needle aspiration (PCNA) were also used when necessary. A specific diagnosis was made in 19 patients (95%). TBNA was diagnostic in all five patients with SCLC, and in 4 of 8 patients with NSCLC (50%). The diagnostic yield of the W-220 and SW-221 needles were not statistically different, but the number of positive aspirates obtained with the W-220 needle was higher than that of the SW-221 needle. Although TBNA was non-diagnostic in bronchoalveolar cell carcinoma, mesothelioma, lymphoma, fibrohistiocytoma and sarcoidosis, the smear obtained with the W-220 needle suggested mesothelioma and lymphoma. We have concluded that TBNA should be used as the first procedure to diagnose and stage bronchogenic carcinoma, because of its minimal invasiveness, absence of complications, and high sensitivity and specificity. The W-220 needle can be used for both central and peripheral lesions. Its diagnostic yield is comparable to that of previous needles. The versatile flow rate enables this needle to diagnose using either smear technique or fluid technique, or to drain a cystic lesion.