Is endobronchial ultrasound-guided transbronchial needle aspiration with a stylet necessary for lymph node screening in lung cancer patients?

Yang, Xu; Lin, Jian; Jin, Yubiao; Wu, Xiaoli; Zheng, Haihong; Jiang, Feng

doi:10.1590/1414-431x20176372

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…The second prospective study compared a group with 2 samples collected with a stylet followed by 2 samples collected without a stylet with a group using the alternate order of collection for the 4 samples. 177 This study indicated no significant sample adequacy differences when stylet was and was not used. However, although the study compared background blood and clot between the collection methods, the study did not compare amount of benign bronchial cells.…”

Section: Additional Discussionmentioning

confidence: 69%

“…Two studies that evaluated the use of a stylet compared with no stylet were identified by the literature search. 176,177 In the first prospective randomized single-blind controlled clinical trial, the authors studied 194 lymph node biopsies in 120 patients. 176 Each lymph node was sampled with and without a stylet by alternating the 2 methods and randomizing the order.…”

Section: Additional Discussionmentioning

confidence: 99%

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Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology

Roy‐Chowdhuri

Đačić

Ghofrani

et al. 2020

Archives of Pathology & Laboratory Medicine

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Context.— The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. Objective.— To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. Methods.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. Results.— Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. Conclusions.— Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens.

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Section: Additional Discussionmentioning

confidence: 69%

Section: Additional Discussionmentioning

confidence: 99%

Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology

Roy‐Chowdhuri

Đačić

Ghofrani

et al. 2020

Archives of Pathology & Laboratory Medicine

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“…Fine needle aspiration (FNA) is a simple, minimally invasive, and highly accurate method widely used in the diagnosis of many organ diseases, including thyroid (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). A stylet can theoretically prevent the lumen of the needle from being blocked by other non-lesion components, including blood, before puncturing into the target lesion, thus allowing fuller aspiration of the target tissue into the needle once the stylet is removed.…”

Section: Introductionmentioning

confidence: 99%

“…Although this assumption of a preference for the use of a stylet seems logical, this assumption has not been demonstrated on an empirical basis. Several studies in other areas of FNA, such as gastrointestinal endoscopy and respiratory endoscopy FNA have shown that the stylet does not improve specimen quality and diagnostic efficiency (3)(4)(5)(6)(7)(8). Besides, some studies have shown that stylet may be associated with an inferior specimen quality (9).…”

Section: Introductionmentioning

confidence: 99%

Effect of a stylet on specimen sampling in thyroid fine needle aspiration: A randomized, controlled, non-inferiority trial

Luo¹,

Mu²,

Ma³

et al. 2023

Front. Endocrinol.

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BackgroundThere is a cost advantage in using a needle without stylet over a needle with stylet in thyroid fine needle aspiration (FNA). This study aimed to elucidate the non-inferiority of thyroid FNA without a stylet (S-) to thyroid FNA with a stylet (S+) on specimen sampling.MethodsIn this study, patients with thyroid nodules undergoing FNA were consecutively enrolled between May 2022 and July 2022. One experienced operator performed two punctures of each nodule with a stylet and without a stylet. Specimen adequacy was the primary outcome. Wald test was used for statistical analysis of the primary outcome. The difference in specimen adequacy between the two methods was expressed as a two-sided 95% confidence interval (CI). The S- method was considered non-inferior to the S+ method if the lower bound of the 95% CI of the S- minus S+ adequacy difference was greater than a predetermined non-inferiority margin of -10%.ResultsA total of 149 patients (195 nodules) were enrolled in the study. A total of 167 of 195 nodules (85.64%) and 169 of 195 nodules (86.67%) were obtained adequate specimens using the S+ and S- methods, respectively. The difference in specimen adequacy (S- minus S+) between the two methods was 1.03% (95% CI, -5.83% to 7.88%). The lower bound 95% CI of the difference in specimen adequacy (-5.83%) was greater than the predetermined non-inferiority margin of -10%. The difference in the yield for malignancy was not significantly different between the two methods.ConclusionThyroid FNA without a stylet is non-inferior to thyroid FNA with a stylet on specimen sampling.

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“…Similarly, the quality of the aspirate and diagnostic performance of EBUS-TBNA have been found to be similar with or without the use of an internal stylet. [5152]…”

Section: Introductionmentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration: Techniques and challenges

Muthu

Sehgal

Dhooria

et al. 2019

J Cytol

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Intrathoracic lymphadenopathy is a common problem encountered in clinical practice and is caused by a wide variety of diseases. Traditionally, the mediastinal lymph nodes were sampled using conventional transbronchial needle aspiration (TBNA), or surgical methods such as mediastinoscopy, and thoracotomy (open or video-assisted thoracoscopy). However, surgical modalities including mediastinoscopy are invasive, expensive, and not universally available. Moreover, they are associated with considerable morbidity and mortality. Conventional TBNA although minimally invasive has a low diagnostic yield. In the last decade, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as the diagnostic procedure of choice in evaluating undiagnosed intrathoracic lymphadenopathy. EBUS-TBNA is also currently the preferred modality in the mediastinal staging of lung cancer. The procedure is minimally invasive, safe, and can be performed as a day-care procedure. In the era of personalized medicine in lung cancer, optimizing the procedure, sample collection, and processing are crucial, as more tissue is required for performing a wide array of molecular tests. Despite its widespread use and acceptance, the diagnostic sensitivity of EBUS-TBNA is still low. To maximize the yield, cytologists and physicians should be aware of the technical details of the procedure. Herein, we discuss the technique of performing EBUS-TBNA, its indications, contraindications, and the processing of the samples at our bronchoscopy suite. We also highlight the challenges faced by the cytologists and clinicians while processing EBUS aspirates.

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Is endobronchial ultrasound-guided transbronchial needle aspiration with a stylet necessary for lymph node screening in lung cancer patients?

Cited by 5 publications

References 17 publications

Effect of a stylet on specimen sampling in thyroid fine needle aspiration: A randomized, controlled, non-inferiority trial

Endobronchial ultrasound-guided transbronchial needle aspiration: Techniques and challenges

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