Needle Fracture during Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspicious Thoracic Lymph Nodes

Abstract

Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is used to make a cytopathologic diagnosis of suspicious lesions located around the gastrointestinal tract. It is a safe technique with few complications. The most common complications of EUS-FNA are related to pancreatic lesions (pancreatitis, bleeding, and abdominal pain). Rare complications have been noted such as stent malfunction, air embolism, infection, neural and vascular injuries, and tumor cell seeding. There are very few studies examining equipment malfunctions. We report a case of needle fracture during the EUS-FNA of suspicious thoracic lymph nodes in a 79-year-old man investigated for unexplained weight loss.

Needle fracture during endoscopic ultrasound-guided fine needle aspiration using a needle with a side hole

“…There are limited reports describing needle fracture as a complication during EUS-FNA. Adamowicz et al reported needle fracture during EUS-FNA of suspicious thoracic lymph nodes 5 . A 22-gauge needle without a side hole was used to puncture the rigid lymph node from the esophagus.…”

Accidental breakage of needle tip during endobronchial ultrasound-guided transbronchial needle aspiration

“…Various authors have reported similar experience as described in [ Supplementary Table 1 ]. [ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ] A nationwide survey by the Japan Society for Respiratory Endoscopy focused on complications associated with EBUS-TBNA aspiration and reported the breakage of the puncture needle in 15 (0.20%) cases. [ 4 ] The details of this complication were not described although reported for first time.…”

“…The first case of needle tip breakage was reported in detail by Özgül et al .,[ 10 ] followed by other reports. [ 11 12 13 14 15 16 17 18 19 20 ] The retrieval of the broken fragment of EBUS needle by flexible bronchoscopy was successfully reported in most of these cases. [ 11 12 14 16 18 19 20 ] Unsuccessful attempts were also reported where fragments migrated to dependent lobes of lung which were expelled by spontaneous coughing[ 8 13 17 ] or migrated to gastrointestinal tract followed by expulsion in faeces.…”

“…[ 7 8 9 ] Needle malfunction in the form of accidental breakage or snapping of its tip during the procedure has also been reported. [ 10 11 12 13 14 15 16 17 18 19 20 ] We herein report an accidental breakage of needle tip as a rare complication while performing EBUS-TBNA procedure in a 58-year-old male suspected to have lung cancer.…”

A rare complication during endobronchial ultrasound-guided transbronchial needle aspiration: Needle assembly malfunction

“…[7] hypothesized that this complication may be related to lymph node stiffness. Certain endoscopic maneuvers as torquing, multiple punctures, fanning in a hard lymph node, and hitting the cartilage could all be predisposing factors,[278] which should be as far as possible avoided.…”