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©2013 UpToDate ® Print Email Recommendations to avoid false positive results during lung cancer staging The fiberoptic bronchoscope should not be connected to the suction apparatus until all TBNA samples have been obtained. The area of interest should be washed with saline or lidocaine, if it is covered with secretions, before needle insertion. The TBNA procedure should be performed prior to airway examination or acquisition of other samples. Lymph nodes denoting worse prognosis should be aspirated first, ie, N3 before N2 and N2 before N1, using the same needle, in patients with multiple sites of nodal involvement. Suction should be released prior to needle withdrawal from the lymph node. Histology specimens should be obtained when appropriate. Reproduced with permission from Minai, OA, Dasgupta, A, Mehta, AC. Transbronchial needle aspiration of central and peripheral lesions. In: Bolliger, CT, Mathur, PN (Eds), Progress in Respiratory Research-Interventional Bronchoscopy. Karger, Basel, Switzerland, 1999.