Transbronchial Needle Aspiration (TBNA)

Transbronchial Needle Aspiration (TBNA) has been a cornerstone of interventional pulmonology for decades, revolutionizing the diagnosis and staging of diseases of the chest. First introduced in 1949 and later adapted for flexible bronchoscopy in the late 1970s, TBNA provides a minimally invasive procedure in which sample tissue is obtained from beyond the central airway walls, primarily from mediastinal and hilar lymph nodes.

Initially performed as conventional TBNA (c-TBNA), guided by anatomical knowledge and pre-procedure imaging ,it has now advanced to Endobronchial Ultrasound-Guided TBNA (EBUS-TBNA), which offers real-time imaging, precise guidance and higher diagnostic accuracy.

TBNA is especially important in evaluating unexplained lymphadenopathy and differentiating conditions with overlapping clinical or radiological features. It is central in staging lung cancer, determining treatment pathways, and distinguishing malignant causes such as lymphoma from benign ones like sarcoidosis or infection (e.g., tuberculosis). By establishing a tissue diagnosis, TBNA avoids unnecessary surgeries, reduces costs, and allows for early, targeted therapy.

In low-resource settings, c-TBNA remains valuable, providing affordable and accessible diagnostics where EBUS is unavailable. Thus, TBNA continues to play a pivotal role in modern respiratory medicine by bridging advanced technology and practical accessibility.