How to increase the yield of transbronchial needle aspiration (TBNA)?

Transbronchial needle aspiration (TBNA) is a relatively sensitive, accurate, and safe technique in the diagnosis and staging of lung cancer. There are many factors influencing the yield of TBNA, such as location and the size of the mediastinal lymphadenopathy (MLN), types of the needle used and the experience of the bronchoscopist. Furthermore, knowledge of anatomy, guidance, availability of rapid on-site evaluation (ROSE) and the number of aspirates, preparation of specimen and interpretations of the cytology and histology of specimens all play important roles. Especially, whether an endobronchial ultrasound (EBUS) is required for TBNA in the diagnosis of mediastinal masses is currently a disputed subject.