Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy

Lin, Xiangmin; Ye, Min; Li, Yuping; Ren, Jing; Lou, Qiyan; Li, Yangyang; Jin, Xiaohui; Wang, Ko Pen; Chen, Chengshui

doi:10.1186/s12890-018-0751-0

Cited by 15 publications

(27 citation statements)

References 29 publications

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“…The biopsy specimens were mostly cytological specimens, and the collection of histological specimens was challenging. 15,36 Using cell blocks as histological specimens, Žemaitis and colleagues compared the diagnostic accuracy of EBUS-TBNA cytological smears and cell blocks. 37 The results showed that the diagnostic accuracy of cell blocks was higher than that of cytological smears.…”

Section: Discussionmentioning

confidence: 99%

Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement

Wang

et al. 2020

Ther Adv Respir Dis

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely used, safe, and accurate technique for obtaining pathological specimens to be used in the diagnosis of diseases involving lung hilar and mediastinal lymph node (LN) enlargement. However, application of the suction technique during EBUS-TBNA remains controversial. In addition, the effectiveness of the slow-pull capillary technique for the diagnosis of pancreatic masses was recently reported. The aim of this study was to compare the diagnostic accuracy of EBUS-TBNA using these two techniques. Methods: The accuracy, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and availability of tissue cores of the suction and slow-pull capillary techniques were studied retrospectively in patients who underwent EBUS-TBNA for the diagnosis of diseases involving lung hilar and mediastinal LN enlargement. Results: A total of 97 patients with hilar and mediastinal LN enlargement underwent EBUS-TBNA; 30 patients underwent the suction technique, 56 patients underwent the slow-pull capillary technique, 5 patients underwent both techniques, and 6 patients had failed operations. The accuracy, sensitivity, specificity, NPV, PPV, and the number of tissue cores obtained with the suction and slow-pull capillary techniques were 66.67% versus 85.71% ( p = 0.039), 43.75% versus 85.42% ( p < 0.001), 92.86% versus 87.5% ( p > 0.05), 59.09% versus 50% ( p > 0.05), 87.5% versus 97.62% ( p > 0.05), and 19 versus 50 ( p = 0.004), respectively. In both univariate and multivariate analyses, the acquisition of tissue core was significantly associated with the diagnostic accuracy of EBUS-TBNA. Moreover, the slow-pull capillary technique was significantly associated with the acquisition of tissue core in EBUS-TBNA. There were no significant differences between the two groups in the blood contamination of samples. Conclusions: Use of the slow-pull capillary technique in EBUS-TBNA can significantly increase the accuracy related to the diagnosis of diseases involving hilar and mediastinal LN enlargement by improving the acquisition of tissue core. The reviews of this paper are available via the supplemental material section.

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Section: Discussionmentioning

confidence: 99%

Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement

Wang

et al. 2020

Ther Adv Respir Dis

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“…EBUS-TBNA is a minimally invasive and safe procedure for the assessment of mediastinal lymphadenopathy [ 5 – 10 ]. We searched the Web of Science and PubMed databases for references using “mediastinal lymph node”, “tuberculosis” and “endobronchial ultrasound-guided transbronchial needle aspiration”.…”

Section: Discussionmentioning

confidence: 99%

“…Although EBUS-TBNA has been successfully used for the diagnosis of mediastinal lymphadenopathy such as MLNTB [ 5 – 10 ], there have no studies reporting the application of EBUS-TBNA in the diagnosis and/or treatment of MLNTAs yet. This may be the first report introducing the employment of EBUS-TBNA to puncture and aspirate pus for diagnosis of MLNTAs and administer drugs to treat MLNTAs.…”

Section: Discussionmentioning

confidence: 99%

“…and inject drugs in lesions [ 4 ]. EBUS-TBNA has recently been developed as a minimally invasive and safe procedure for the diagnosis of mediastinal lymphadenopathy such as MLNTB [ 5 – 8 ], mediastinal lymphoma [ 9 ], and mediastinal staging of lung cancer [ 10 ], with satisfactory safety and accuracy. However, the application of EBUS-TBNA in the diagnosis and treatment of MLNTA has not been reported yet.…”

Section: Introductionmentioning

confidence: 99%

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Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess: a case report and literature review

Fang

Cheng

Guo

et al. 2020

J Cardiothorac Surg

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Background This study aimed to report the experience of diagnosis and treatment of one rare case of mediastinal lymph node tuberculous abscess (MLNTA) using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Case presentation An 18-year-old female patient was hospitalized in the Affiliated Hospital of Xuzhou Medical University in November 2017, due to intermittent left chest pain. She was suspected of infecting tuberculosis (TB) and thus received anti-TB treatment. Since April 1, 2018, she began to exhibit symptoms of chest distress. The patient was then admitted to Shanghai Pulmonary Hospital and continued receiving systemic anti-TB treatment during the whole course. On April 11, 2018, she received EBUS-TBNA to puncture pus and inject isoniazid. Simultaneously, the pus was sent for cytopathological and bacteriological examination, both supporting the diagnosis of TB in the patient. On April 24 and May 10, she received two times of EBUS-TBNA treatment. The symptoms of chest distress were relieved, but granulomatous neoplasm occurred at the EBUS-TBNA site on the trachea wall. The patient then received local clamp removal and cryotherapy on May 29 and Jul 19, respectively. Chest computed tomography (CT) reexamination on September 28 revealed that the MLNTA lesion had been completely absorbed, and electronic bronchoscopic reexamination on September 30 demonstrated that the granulomatous neoplasm on the trachea wall was entirely invisible. Conclusions Using EBUS-TBNA to puncture and aspirate pus and inject drugs can be effectively used to diagnose and treat MLNTA, which provides a new, less invasive, safe and reliable method for diagnosis and treatment of MLNTA.

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“…Assessment and sampling of enlarged mediastinal lymph nodes have traditionally been done using exible bronchoscopy-guided transbronchial needle aspiration (TBNA), CT-guided biopsy or mediastinoscopy. Since the past decade, Endobronchial ultrasound-guided TBNA (EBUS-TBNA) has become an essential investigation in accessing mediastinal structures, providing sample adequacy of 85 to 93%, (1,2) and a diagnostic yield ranging from 37 to 90 %. (3,4) Several factors are known to in uence the yield of EBUS-TBNA, including the needle size,(5) number of passes performed, (6) and nodal size.…”

Section: Introductionmentioning

confidence: 99%

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

Mohan

Iyer

Madan

et al. 2021

Preprint

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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.

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Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy

Cited by 15 publications

References 29 publications

Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement

Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess: a case report and literature review

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

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