Medical disclaimer: This page is educational. It is not a substitute for a clinical consultation. If you have been told you need a needle biopsy of mediastinal lymph nodes, please discuss the right approach with your treating doctor.
TBNA Bronchoscopy in Hyderabad: When Needle Sampling Through the Airway Is the Right Call
A patient sat across from me last month with a chest CT showing a 22 mm right paratracheal lymph node. Their referring physician had written “needle biopsy through bronchoscopy” on the referral. They assumed that meant EBUS, because the internet had told them EBUS was the modern way.
It can be. It often is. Sometimes the answer is simpler. TBNA stands for transbronchial needle aspiration. A thin needle passes through the wall of your airway during a flexible bronchoscopy. The target is a lymph node sitting just outside that wall. At Respire we run both conventional TBNA and the ultrasound-guided upgrade called EBUS-TBNA. The right tool depends on the node and what the sample needs to answer.
Written by Dr. Kunal Waghray, MD DM DNB MNAMS EDRM, Interventional Pulmonologist, Respire Airway Clinics, Hyderabad. Published 15 May 2026.
Dr. Kunal Waghray
Interventional Pulmonologist
MD DM DNB MNAMS EDRM
- 1,000+ bronchoscopy and pleural procedures performed
- DM Pulmonology, Amrita Institute of Medical Sciences
- Both conventional TBNA and EBUS-TBNA performed at Respire
- GeneXpert and ROSE-assisted sampling available
What TBNA Actually Is
TBNA is a needle pass through the airway wall, not a brush or a forceps bite inside the airway. The bronchoscope sits in your central airway. A retractable needle, around 21 to 22 gauge for cytology, is advanced through the working channel. The operator pushes it through the soft cartilage gap of the trachea or a bronchus and into the lymph node behind it. Suction draws cells back into the needle. The needle retracts, and the sample goes to the pathologist.
Conventional TBNA uses chest CT images and airway landmarks to guide the needle. The operator decides where the node is in relation to the cartilage rings before the procedure and aims accordingly. There is no real-time imaging during the puncture itself.
How is it different from EBUS-TBNA?
EBUS-TBNA is the same idea with a sonographic upgrade. A bronchoscope with an ultrasound probe at the tip lets the operator see the lymph node on a screen in real time. Picture conventional TBNA as a careful blind cast, and EBUS-TBNA as a guided cast with the fish on screen. The two techniques share the needle, the airway, and the sedation.
Is it part of a normal bronchoscopy?
Yes. The procedure feels like a standard flexible bronchoscopy because it is one. The TBNA adds a needle pass at the relevant station. When a bronchoscopy is being done for a separate airway lesion, conventional TBNA is a quick add-on that takes ten to fifteen minutes.
When We Use Conventional TBNA, and When EBUS-TBNA Is the Better Call
Accuracy gap: Published series put conventional TBNA sensitivity for malignant mediastinal nodes at around 60 to 70 per cent in experienced hands. EBUS-TBNA sensitivity sits at 90 per cent or higher in the same indication. A 2014 meta-analysis showed EBUS-TBNA had nearly three times the diagnostic odds of conventional TBNA for mediastinal masses (PubMed 24649325). We do not pretend otherwise.
So why does conventional TBNA still have a place? Three reasons.
Large nodes in classic locations
A 2 cm subcarinal or right paratracheal node in a textbook position can yield diagnostic cells on conventional TBNA. The node fills the available space, and the needle does not have to find it.
Cost and access
Conventional TBNA is included within a standard flexible bronchoscopy. EBUS adds equipment, a separate suite, and a higher fee. In a TB-endemic setting, the differential often weights toward infection. A positive conventional TBNA result can answer the question at the lower price point.
Adjunct sampling
When a bronchoscopy is being done for a separate airway lesion, conventional TBNA is a quick add-on that takes minutes and can add diagnostic value at negligible extra time or cost.
When EBUS-TBNA is the right call
- Small nodes, under about 1 cm
- Posterior nodes not adjacent to a clear cartilage landmark
- Definitive mediastinal staging before thoracic surgery, where a single false-negative changes treatment
- Patients where one negative result is not enough and high certainty is required
For details on the guided upgrade, see our page on EBUS in Hyderabad.
How TBNA Is Performed at Respire
The procedure feels like a standard flexible bronchoscopy because it is one. We add a needle pass at the relevant station. The full bronchoscopy walkthrough is on the bronchoscopy in Hyderabad page; here are the points specific to TBNA.
Before the procedure
You fast for six hours. We review your CT scan and identify the target node and station. You sign a consent that names TBNA, the lymph node station, and the expected number of passes. Blood thinners are paused for the window your cardiologist agrees to.
Sedation and airway preparation
You are sedated through an intravenous line. Topical lignocaine numbs your throat and airways. The flexible bronchoscope enters through your nose or mouth, depending on what is comfortable.
Airway inspection
We inspect the entire visible airway first: the vocal cords, trachea, carina, and the lobar and segmental bronchi on the relevant side. Any abnormal mucosa or lesions are noted.
Needle positioning and puncture
The scope is positioned at the target station identified on your CT. A retractable needle is advanced through the working channel, pushed through the cartilage gap into the lymph node behind it, and suction is applied.
Sample collection and ROSE
We typically take three to four passes per station to raise diagnostic yield. If rapid on-site evaluation (ROSE) is available, a cytopathologist checks the slide at the bedside. When the sample is confirmed adequate, we stop. When it looks thin, we take more passes.
Recovery
You recover in the day-care area for one to two hours. We watch your oxygen levels, pulse, and listen to your chest. If everything is normal, you go home with a chaperone. You should not drive or sign legal documents that day.
How long?
30 to 45 minutes for the full bronchoscopy. The TBNA portion adds 10 to 15 minutes.
General anaesthesia?
No. Conscious sedation and topical lignocaine. Day-case procedure.
Same-day discharge?
Yes. Most patients go home one to two hours after the procedure with a chaperone.
What TBNA Can Diagnose
In Hyderabad practice, most TBNA samples answer one of three questions: cancer, tuberculosis, or sarcoidosis. The sample is split into portions depending on which diagnoses need to be excluded.
Lung cancer
Cytology looks for malignant cells and the tumour subtype. The pathologist runs immunohistochemistry on cell-block material to distinguish adenocarcinoma from squamous and small cell cancers. This feeds the staging and treatment decision.
Tuberculosis lymphadenitis
One portion goes for cytology (granulomas and caseation). Another goes for GeneXpert MTB/RIF, detecting mycobacterial DNA within hours. A third goes for mycobacterial culture. India carries the highest global burden of extrapulmonary TB.
Sarcoidosis
Cytology finds non-caseating granulomas. GeneXpert and TB culture return negative. The clinical picture, CT pattern, and ACE level support the diagnosis.
Mediastinal lymphadenopathy
Lymphoma, metastatic cancer from extrathoracic primaries, fungal infection, and other causes of enlarged mediastinal nodes can all be sampled.
Most diagnoses arrive within three to five working days. GeneXpert is faster. TB culture takes weeks but rarely changes initial treatment. The full staging context for lung cancer lives on our page on lung cancer diagnosis and staging.
Safety, Risks, and What to Expect Afterwards
How safe is conventional TBNA?
Published community-practice series put the serious complication rate at around 0.3 per cent (PMC4700362). Conventional TBNA is considered a low-risk extension of flexible bronchoscopy.
What are the recognised risks?
Bleeding at the puncture site (almost always minor and self-limiting), pneumothorax (rare, because the needle is aimed into a node, not the lung itself), mediastinitis (uncommon), and a sore throat for a day. These are discussed during the pre-procedure consultation.
When will I get results?
Cytology results arrive in 3 to 5 working days. GeneXpert returns within hours when ordered. Mycobacterial culture takes up to 6 weeks but is definitive when positive.
Warning signs to act on
Call the clinic if you develop fever above 38.5°C, chest pain that worsens, or breathlessness that is new after the procedure. These are uncommon but worth flagging early.
Cost and Where to Have TBNA in Hyderabad
Conventional TBNA is performed within the bronchoscopy fee at Respire. There is no separate procedure charge for the needle pass itself, beyond the consumable cost of the needle. EBUS-TBNA carries a higher fee because it uses dedicated equipment.
A pre-procedure consultation lets us review your CT and choose the right approach. We then quote you the inclusive cost. We do not upgrade you to EBUS-TBNA when conventional TBNA will answer the question. We do not downgrade you to conventional TBNA when the staging decision needs the higher accuracy.
Frequently Asked Questions
Is TBNA the same as EBUS?
No. TBNA is the needle technique, and EBUS is the ultrasound guidance added to it. Conventional TBNA passes the needle using CT landmarks alone. EBUS-TBNA passes the same needle while the operator watches the target on real-time ultrasound. The two techniques share the airway and the sedation but differ in whether the target is visualised as the needle moves.
Is conventional TBNA still used now that EBUS exists?
Yes, in selected patients. Large nodes in classic locations are one valid indication. Adjunct sampling during a bronchoscopy done for another reason is another. Settings where the differential is heavily TB-weighted are a third. EBUS-TBNA remains the first choice for definitive mediastinal staging before surgery.
How accurate is TBNA for diagnosing cancer?
Published series put conventional TBNA sensitivity for malignant mediastinal lymph nodes at around 60 to 70 per cent in experienced hands. EBUS-TBNA sits at 90 per cent or higher in the same indication. Yield improves with operator experience, larger nodes, and multiple passes per station.
Is TBNA painful?
You are sedated and your airways are numbed with topical lignocaine. You do not feel the needle. Some patients recall a brief cough during the procedure, and most recall almost nothing.
How long does a TBNA procedure take?
The full bronchoscopy with TBNA usually takes 30 to 45 minutes. The TBNA portion itself adds about 10 to 15 minutes. Recovery in the day-care area is one to two hours.
What is the recovery time after TBNA?
You go home the same day with a chaperone. Most patients return to office work the next morning. Your throat may feel raw for 24 hours, and a small blood streak in spit for a day is normal.
What is TBNA used to diagnose?
Mediastinal lymphadenopathy of unclear cause, lung cancer staging, suspected TB lymphadenitis, and sarcoidosis are the four most common uses. Less often, TBNA samples a peribronchial mass or a submucosal airway lesion.
When would my doctor choose EBUS-TBNA over conventional TBNA?
For small nodes under about 1 cm, posterior nodes not adjacent to a clear cartilage landmark, and definitive mediastinal staging before thoracic surgery where a single false-negative changes treatment. If your treating team has decided EBUS-TBNA is needed for staging accuracy, conventional TBNA is not a substitute.
Book a TBNA Assessment with Dr. Kunal Waghray
If your scan shows enlarged mediastinal lymph nodes and a needle biopsy has been advised, the next step is one consultation. Bring your CT scan and any prior reports. We will review the imaging, choose the right approach for your case, and walk you through what the procedure looks like.