“A Randomized Comparison of Sample Adequacy and Diagnostic Yield of EBUS-TBNA using various Suction Pressures”

Abstract

Introduction: The evidence for using vacuum suction during EBUS is sparse, and the optimal suction pressure for obtaining adequate samples is not yet determined.Objectives: To assess the influence of suction on adequacy and diagnostic yield of EBUS TBNA.Methods: This single-center, prospective, randomized, non-inferiority trial assessed whether no-suction and 10 ml suction are non-inferior to 20 ml suction for adequacy and diagnostic yield of EBUS-TBNA aspirates.Results: 323 lymph nodes were sampled using EBUS-TBNA. Baseline characteristics of lymph nodes were comparable in the three suction groups. The overall adequacy of EBUS-TBNA aspirates in the "No-suction," 10ml, and 20ml suction was 90%, 83.49%, and 77.88%, respectively. The difference in the adequacy was groups 12.12% (95%CI: 3.93 - 20.3) and 5.61% (95%CI: -3.27- 14.49) for no-suction versus 20ml and 10ml versus 20ml suction, respectively. No-suction and 10 ml were non-inferior to 20 ml suction in terms of sample adequacy. At a superiority margin of 3.92%, no-suction was superior to 20 ml suction for sample adequacy (p<0.05). The overall diagnostic yield was comparable (63.6%, 52.3%, and 57.7% in 0, 10 ml, and 20 ml, respectively; p-not significant). The proportion of aspirates which were predominantly blood was similar (No-suction -10.9%, 10ml - 13.8%, 20ml - 15.4%; p=0.62)Conclusions: EBUS-TBNA with or without the application of vacuum suction does not influence specimen adequacy and diagnostic yield. “No-suction” is superior to 20ml suction pressure and is associated with a lesser risk of bloody samples.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Technical Updates and Pathological Yield

“…Prospective, randomized, non-inferiority trial comparing no suction to 10 mL and 20 mL of suction ( n = 323 lymph node) [ 16 ]…”

“…A 20 cm suction is then applied, and aspiration is done by moving the needle in the lymph node 10 to 20 times. The addition of suction has not been shown to improve the diagnostic yield or sample adequacy when compared with lower suction of 10 cm or no suction at all [ 16 , 17 , 18 ].…”