The Effect of Aspiration Pressure Over Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration on the Diagnosis of Intrathoracic Lymphadenopathies

Boonsarngsuk, Viboon; Pongtippan, Atcharaporn; Juthakarn, Sabaithip

doi:10.1007/s00408-013-9480-6

Cited by 8 publications

(8 citation statements)

References 13 publications

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“…They also found that higher negative pressure was superior to lower negative pressure for obtaining adequate cytological specimens. 28…”

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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“…They also found that higher negative pressure was superior to lower negative pressure for obtaining adequate cytological specimens. 28…”

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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“…The authors reported no difference in sample adequacy, sample quality, diagnostic yield and specific diagnostic yield for malignancy [27]. A smaller prospective study by Boonsarngsuk et al [28] compared EBUS-TBNA with different levels of pressure: 0 (no suction), and -20 and -40 cm H 2 O. In this study, only 1 biopsy was performed at each LN with a different pressure level (0, and -20 and -40 cm H 2 O).…”

Section: Results Of Pico Questionmentioning

confidence: 99%

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

et al. 2014

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Rationale: Conventional transbronchial needle aspiration (TBNA) and endobronchial ultrasound (EBUS)-TBNA are widely accepted tools for the diagnosis and staging of lung cancer and the initial procedure of choice for staging. Obtaining adequate specimens is key to provide a specific histologic and molecular diagnosis of lung cancer. Objectives: To develop practice guidelines on the acquisition and preparation of conventional TBNA and EBUS-TBNA specimens for the diagnosis and molecular testing of (suspected) lung cancer. We hope to improve the global unification of procedure standards, maximize the yield and identify areas for research. Methods: Systematic electronic database searches were conducted to identify relevant studies for inclusion in the guideline [PubMed and the Cochrane Library (including the Cochrane Database of Systematic Reviews)]. Main Results: The number of needle aspirations with both conventional TBNA and EBUS-TBNA was found to impact the diagnostic yield, with at least 3 passes needed for optimal performance. Neither needle gauge nor the use of miniforceps, the use of suction or the type of sedation/anesthesia has been found to improve the diagnostic yield for lung cancer. The use of rapid on-site cytology examination does not increase the diagnostic yield. Molecular analysis (i.e. EGFR, KRAS and ALK) can be routinely performed on the majority of cytological samples obtained by EBUS-TBNA and conventional TBNA. There does not appear to be a superior method for specimen preparation (i.e. slide staining, cell blocks or core tissue). It is likely that optimal specimen preparation may vary between institutions depending on the expertise of pathology colleagues.

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“…On the other hand, few studies have reported better yields with higher suction pressure. Boonsarngsuk et al [8] compared 0 mL, 20 mL, and 40 mL suction pressure in EBUS-TBNA and found no difference in the adequacy and diagnostic yield between 20 mL and 40 mL suction pressure. However, both of these were superior to the results obtained by zero suction.…”

Section: Discussionmentioning

confidence: 99%

“…Several factors are known to influence the yield of EBUS-TBNA, including: the needle size [5], number of passes performed [6], and nodal size [4]. In clinical practice, EBUS-TBNA is commonly performed by applying vacuum suction, although evidence regarding its utility is inconsistent [7,8]. Consequently, a recent technical Working Group report also suggested that EBUS-TBNA may be performed with or without the application of suction [9].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Comparison of Sample Adequacy and Diagnostic Yield of Various Suction Pressures in EBUS-TBNA

Iyer

Madan

Hadda

et al. 2021

Advances in Respiratory Medicine

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The Effect of Aspiration Pressure Over Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration on the Diagnosis of Intrathoracic Lymphadenopathies

Abstract: Negative pressure should be applied in an EBUS-TBNA procedure. Although the diagnostic yield was not different, high negative pressure was superior to low negative pressure in obtaining numbers of adequate cells.

Cited by 8 publications

References 13 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

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

A Randomized Comparison of Sample Adequacy and Diagnostic Yield of Various Suction Pressures in EBUS-TBNA

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