Dear Editor,

We read the publication on “Characterization of Lesions: Significant impact on lung cancer diagnosis with use of transbronchial needle aspiration (TBNA) in comparison to conventional diagnostic techniques,” with a great interest.[1] Patil and Rujuta concluded that “Bronchoscopic characterization of lesions and use of technique accordingly during bronchoscopy has a significant outcome in the form of yield; also, it will decrease the need for repeat bronchoscopy.” In fact, use of any additional diagnostic procedure can increase the diagnostic property. Nevertheless, there are some issues for consideration. First, there is an cost of additional procedure. The cost-effectiveness should be evaluated. Second, an additional procedure implies a longer medical procedure. There might be an increased possibility of complication in a more complex procedure. The possible important complications due to additional TBNA are mediastinitis and pneumothorax.[2],[3] A dysfunction of the forceps steering during TBNA is a common pitfall during TBNA procedure that can lead to complications.[4] In case with a very long TBNA procedure, jaw dislocation is a possible unwanted complication.[5] According to a recent report by Oki et al., it requires several passes to get adequate diagnostic materials; hence, there is a high chance of failure of procedure.[6] In conclusion, TBNA might be useful in diagnosis, but there are many considerations on the technique. The study on the cost-effectiveness is required and there is a need to perform further comparative risk and benefit analysis. To increase the efficacy of TBNA, the use of additional real-time endobronchial ultrasound guidance is proven useful.[7]

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