In this prospective study, we aimed to report our experience with the diagnostic utility of transbronchial needle aspiration (TBNA) in patients with malignant endobronchial lesions detected during routine bronchoscopy. Ninety-four patients were enrolled. TBNA and conventional diagnostic techniques (CDTs: forceps biopsy, brushing, and washing) were performed in all patients. Endobronchial lesions were classified into exophytic mass lesions (EMLs), submucosal disease (SD), and peribronchial disease (PD). The diagnostic yields of TBNA and CDT alone and together were compared according to the lesions’ types, histopathology, and locations. During 3-year period, the addition of TBNA to CDT improved bronchoscopic sensitivity from 70.2% to 94.7% in all lesion types. Addition of TBNA to CDT increased the diagnostic success from 74% to 95% and from 50% to 94% in NSCLC and SCLC, respectively. The diagnostic success was increased in all localizations by the addition of TBNA to CDT, particularly for lesions located at the trachea, main bronchi, and upper lobes. We conclude that the addition of TBNA to CDT increases the diagnostic yield in patients with visible malignant endobronchial lesions, particularly in peribronchial disease, and improves the diagnostic yield of bronchoscopy, in both NSCLC and SCLC and in all bronchoscopic locations, particularly in central and upper lobar lesions. 1. Introduction Transbronchial needle aspiration (TBNA) is a modality that allows the bronchoscopist to sample tissue from the deeper submucosa as well as from the close extraluminal areas of the endobronchial tree. TBNA is a beneficial, safe, and minimally invasive technique that was proved to be useful in the diagnosis and staging of lung cancer [1]. Previously, the utility of TBNA was restricted to mediastinal lymph node and extrabronchial lesion sampling. Its use has been expanded to complement conventional diagnostic techniques (CDTs) such as bronchial washing (BW), bronchial brushing (BB), and forceps biopsy (FB) in the diagnosis of endobronchial lung cancer [2]. However, only few studies [2–7] had addressed the diagnostic utility of TBNA in visible endobronchial lung cancer. Moreover, despite that TBNA proved cost-effective diagnostic utility in visible malignant endobronchial lesions [8], studies evaluating that utility in developing countries are still lacking. Lung cancer may present either as a parenchymal lesion or as endobronchial disease. The latter may manifest as an exophytic mass lesion (EML), submucosal infiltration (submucosal disease, SD), or extrinsic compression
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