Clinical evaluation of the utility of a flexible 19-gauge EBUS-TBNA needle

Kinoshita, Tomonari; Ujiie, Hideki; Schwock, Joerg; Fujita, Kosuke; McDonald, Christine M.; Lee, Chang Young; Gregor, Alexander; Tyan, Chung Chun; Houston, Simon; Czarnecka-Kujwa, Kasia; Asamura, Hisao; Yasufuku, Kazuhiro

doi:10.21037/jtd.2018.04.50

Cited by 27 publications

(25 citation statements)

References 21 publications

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“…One systematic review from a clinical practice guideline produced on behalf of the World Association of Bronchology and Interventional Pulmonology Task Force, 27 2 randomized controlled trials (RCTs), 28,29 2 prospective cohort studies, 30,31 and 4 retrospective cohort studies [32][33][34][35] comprise the evidence base for statement 2. The systematic review 27 carried a low risk of bias, with the only limitation being unclear reporting of whether the study used dual study selection and data extraction.…”

Section: Guideline Statements Endobronchial Ultrasound-guided Transbronchial Proceduresmentioning

confidence: 99%

“…The systematic review 27 carried a low risk of bias, with the only limitation being unclear reporting of whether the study used dual study selection and data extraction. Both RCTs, 28,29 1 prospective cohort study, 31 and all the retrospective cohort studies [32][33][34][35] were published after the search date of the systematic review. The aggregate risk of bias across these studies was very serious.…”

Section: Guideline Statements Endobronchial Ultrasound-guided Transbronchial Proceduresmentioning

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: Guideline Statements Endobronchial Ultrasound-guided Transbronchial Proceduresmentioning

confidence: 99%

Section: Guideline Statements Endobronchial Ultrasound-guided Transbronchial Proceduresmentioning

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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“…For common indications, commercially available 21-or 22-gauge (G) needles were shown to be safe and equally effective in providing adequate diagnostic yield (5). More recently, a 19G needle has become commercially available and may provide the advantage of yielding larger cell blocks, possibly allowing to reduce the number of needle passes and overall procedure time, without compromising diagnostic accuracy (42)(43)(44). Biopsy specimens can also be obtained by transbronchial forceps introduced into the target lesion via the bronchial wall opening already established by the TBNA needle, thus providing histology-grade specimens and potentially increasing the diagnostic yield in certain benign and malignant conditions (45,46).…”

Section: Utility Of Convex-probe Ebus and Transbronchial Needle Aspiration In The Icumentioning

confidence: 99%

An evolving role for endobronchial ultrasonography in the intensive care unit

Kalchiem‐Dekel¹,

Hossain²,

Gauran³

et al. 2021

J Thorac Dis

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Endobronchial ultrasound (EBUS) bronchoscopy is an established minimally-invasive modality for visualization, characterization, and guidance of sampling of paratracheal and parabronchial structures and tissues. In the intensive care unit (ICU), rapidly obtaining an accurate diagnosis is paramount to the management of critically ill patients. In some instances, diagnosing and confirming terminal illness in a critically ill patient provides needed closure for patients and their loved ones. Currently available data on feasibility, safety, and yield of EBUS bronchoscopy in critically ill patients is based on single center experiences. These data suggest that in select ICU patients convex and radial probe-EBUS bronchoscopy can serve as useful tools in the evaluation of mediastinal lymphadenopathy, central airway obstruction, pulmonary embolism, and peripheral lung lesions. Barriers to the use of EBUS bronchoscopy in the ICU include: (I) requirement for dedicated equipment, prolonged procedure time, and bronchoscopy team expertise that may not be available; (II) applicability to a limited number of patients and conditions in the ICU; and (III) technical difficulty related to the relatively large outer diameter of the convex probe-EBUS bronchoscope and an increased risk for adverse cardiopulmonary consequences due to intermittent obstruction of the artificial airway. While the prospects for EBUS bronchoscopy in critically ill patients appear promising, judicious patient selection in combination with bronchoscopy team expertise are of utmost importance when considering performance of EBUS bronchoscopy in the ICU setting.

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“…Our cohort consists of a wide range of lymphoma subtypes across 23 patients, in comparison to previous 19G studies containing four or fewer patients with lymphoma. 12,[26][27][28][29] However, this series is limited by its nature as a single-centre study. The ability of our centre to facilitate ROSE of small-volume specimens by experienced pathologists mean that our results may not be generalisable to other institutions.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Diagnostic performance of 19‐gauge endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in suspected lymphoma: A prospective cohort study

Lim

Steinfort

Irving

2020

Clinical Respiratory J

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Introduction Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) represents a minimally invasive approach in the evaluation of mediastinal/hilar lymphadenopathy. Diagnostic performance of EBUS‐TBNA in lymphoma using standard 22‐gauge (22G) needle is limited by sample volumes that are often inadequate for histopathological assessment. Objectives To evaluate the diagnostic utility of 19‐gauge (19G) EBUS‐TBNA needle in the evaluation of suspected lymphoma. Methods We prospectively collected clinical and procedural information for patients undergoing EBUS‐TBNA with 19G needle at Royal Melbourne Hospital for investigation of mediastinal/hilar lymphadenopathy, where lymphoma was considered in the differential diagnosis. All consecutive patients between June 15, 2016 and July 10, 2019 were included. If definitive diagnosis was not achieved on EBUS‐TBNA, final diagnosis was determined through subsequent investigation or a minimum of 6 months radiologic surveillance. Results Thirty‐nine patients underwent EBUS‐TBNA using 19G needle for evaluation of suspected lymphoma. Thirteen patients had a prior diagnosis of lymphoma (33%). Lymphoma was ultimately diagnosed in 23 patients (59%). Of these, 10 had a prior diagnosis of lymphoma (43%). 19G EBUS‐TBNA demonstrated lymphoma in 19 patients, with a sensitivity of 83% (95% CI 66‐93) for detection of lymphoma. Four patients required surgical biopsy to definitively characterise lymphoma subtype. Therefore, sensitivity of 19G EBUS‐TBNA for definitive diagnosis of lymphoma was 65% (95% CI 45‐81). In patients with a prior diagnosis of lymphoma, sensitivity for definitive diagnosis of lymphoma was 80% (95% CI 48‐95). Conclusion Diagnostic performance of 19G EBUS‐TBNA appears similar to standard 22G needle in detection and definitive diagnosis of lymphoma. Further invasive testing remains necessary following non‐diagnostic EBUS‐TBNA procedures.

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Clinical evaluation of the utility of a flexible 19-gauge EBUS-TBNA needle

Abstract: The Flex 19G is safe and provides larger volumetric and cohesive tissue samples that are appropriate for histopathological processing. The final version of the Flex 19G could be a good choice in selected cases where greater tissue acquisition is required.

Cited by 27 publications

References 21 publications

An evolving role for endobronchial ultrasonography in the intensive care unit

Diagnostic performance of 19‐gauge endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) in suspected lymphoma: A prospective cohort study

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