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

Abstract

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.

Comparison of adequacy between transbronchial lung cryobiopsy samples and endobronchial ultrasound‐guided transbronchial needle aspiration samples for next‐generation sequencing analysis

“…Moreover, there was a high concentration of crushed tumor cells and low tumor content in fully inadequate samples for NGS analysis in the TBNA group. Blood contamination was also detected in the EBUS‐TBNA samples, as reported in previous studies 31,32 . These unfavorable conditions detected on the EBUS‐TBNA samples could inhibit NGS analysis.…”

“…Blood contamination was also detected in the EBUS-TBNA samples, as reported in previous studies. 31,32 These unfavorable conditions detected on the EBUS-TBNA samples could inhibit NGS analysis. Because NGS analysis requires a definite amount of DNA and RNA, a sample with a high number of uncrushed tumor cells should be used.…”

Suitability of Bronchoscopic Biopsy Tissue Samples for Next-Generation Sequencing

“…The tumor content ratio of the EBUS-TBNA samples was lower than that of the EBUS-GS and EBB samples, and the proportion of patients with a tumor content ratio of ≥ 30% was only 36.0% in the EBUS-TBNA subgroup. Blood contamination was detected in the EBUS-TBNA samples, which could have affected the tumor content ratio [23,24]. The low tumor content ratio in the EUBS-TBNA samples and the high concentration of crushed tumor cells could reduce the success rate of NGS analyses [22].…”

Rapid On-site Evaluation (ROSE) in Capillary Pull Versus Suction Biopsy Technique With Endobronchial Ultrasound-transbronchial Needle Aspiration (EBUS-TBNA)

“…This study had shown no significant difference in diagnostic accuracy for the 2 techniques, but had not examined ROSE outcomes or procedure times. 6 Subsequent to these guidelines, however, He et al 17 published a comparison of these techniques in 96 patients that suggested improvement in final diagnostic accuracy with capillary pull, providing conflicting evidence; this paper also did not assess ROSE outcomes. When comparing these 2 techniques in the EUS pancreas literature, the evidence is also controversial.…”

“…Although we hypothesized the force of suction would increase blood contamination, our study population had no difference in blood contamination scores for the 2 techniques, which is a result shared by other studies. 17,[25][26][27] In terms of blood contamination at ROSE, the CHEST guideline panel dose advocate removing suction if there is abundant blood seen on prior sample. 10 We initially hypothesized procedural time could be shortened by reducing the total number of passes required to achieve an adequate sample in the capillary group.…”