Utility of a 25- Versus 22-G EBUS Needle in Difficult-to-Access 2R Lymph Nodes

Gafoor, Khalid; Belete, Habtamu; Walczyszyn, Maciej; Zapata, Daniel; Husta, Bryan

doi:10.1097/lbr.0000000000000428

Cited by 3 publications

(5 citation statements)

References 2 publications

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“…The sampling rate and diagnostic yield obtained in this study were comparable to those obtained with traditional 22-G needles (3,4,6). However, a wide range of LNs, including those that were difficult to approach using 22-G needles (17,18), were aspirated using 25-G needles.…”

Section: Discussionsupporting

confidence: 61%

“…Jhun et al reported that the diagnostic sensitivity and NPV of left-sided LNs were lower than those of midline or rightsided LNs (17). Gafoor et al reported that #2 LNs were difficult to access due to limited flexion of the bronchoscope when the needle was applied (18). However, these authors achieved EBUS-TBNA for #2R with the 25-G needle, after failure with the 22-G needle.…”

Section: Discussionmentioning

confidence: 99%

“…Lung cancer is the leading cause of cancer incidence and mortality worldwide. Approximately 2.1 million new cases and 1.8 million deaths were reported in 2018, accounting for nearly 18.4% of all cancer-related deaths (1). The most important prognostic factor for lung cancer is disease stage, using the tumour-node-metastasis (TNM) classification of malignant tumours (2).…”

Section: Introductionmentioning

confidence: 99%

“…Accurate LN staging with EBUS-TBNA is increasingly important, as the prognosis of patients with unresectable stage III disease has improved significantly with chemoradiotherapy followed by durvalumab, an anti-programmed cell death ligand-1 antibody (16). Nevertheless, the standard 22-gauge (22-G) needle has some structural limitations, owing to its flexibility and penetrability; therefore, some stations approached at an acute angle are difficult to puncture (e.g., #2R/L, #3p, and #4L) (17,18). Meanwhile, a thinner 25-gauge (25-G) needle was introduced in Japan at the end of 2016.…”

Section: Introductionmentioning

confidence: 99%

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Clinical validity of 25-gauge endobronchial ultrasound-guided transbronchial needle in lymph node staging of lung cancer

et al. 2021

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration is recommended for lymph node (LN) staging in lung cancer. Although 22-gauge needles are widely used, they may make some stations difficult to puncture owing to an acute angle. A thinner 25-gauge needle was introduced in Japan at the end of 2016 and offered structural advantages such as improved flexibility and penetrability. We aimed to validate the clinical utility of the 25-gauge needle in LN staging. Methods: Patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration for LN staging of lung cancer using the 25-gauge needle at our institution between November 2016 and March 2019 were included. Patient characteristics, staging procedures, pathology findings, and genetic testing success rates were assessed. Results: Data of 130 patients were included in the analysis. The sampling rate was 87.6% (589/672 lesions).In addition to stations #4R, #7, and #11, which are generally easy to puncture, multiple stations (40.1%) were sampled. The diagnostic accuracy of combined computed tomography and fluorodeoxyglucose positron emission tomography was 82.3% and that of additional endobronchial ultrasound-guided transbronchial needle aspiration was 96.9%. The overall sensitivity, specificity, and positive and negative predictive values validated using resected specimens were 97.1% (34/35), 100% (41/41), 100% (34/34), and 97.6% (41/42), respectively. The success rate of genetic testing was 100% (34/34). Conclusions: The new 25-gauge needle enabled us to approach a wide range of LNs with a desirable sampling rate and diagnostic accuracy in LN staging using endobronchial ultrasound-guided transbronchial needle aspiration, while providing enough tissue for genetic testing.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical validity of 25-gauge endobronchial ultrasound-guided transbronchial needle in lymph node staging of lung cancer

et al. 2021

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“…Gafoor and colleagues in a small case series of 4 patients were able to obtain an adequate sample from difficult-toaccess 2R lymph nodes when the 22-G needle was unsuccessful; suggesting that having a smaller sheath diameter makes the needle more flexible and might have an advantage to access smaller lesions. 5,9 Another distinguishable characteristic of the Boston Scientific 25-G needle is its composition made of cobalt chromium, which can theoretically allow the operator to reach more difficult lymph nodes. This metal may offer greater tensile properties, penetration and resistance to deformity when compared with stainless steel that is present in the Olympus 22-G needle.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Sample Adequacy and Diagnostic Yield of the 21-G and 25-G EBUS TBNA Needles

Sood

Alape

Thakkar

et al. 2021

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) of mediastinal lymphadenopathy has been shown to be equivalent and possibly even superior to mediastinoscopy. Since the original dedicated 22-G aspiration needle, 21-G, 25-G, and recently 19-G needles have been introduced. Smaller needles may be more flexible and adept at accessing more difficult nodes, and may have less blood contamination compared with larger needles.Patients and Methods: This is a prospective observational study of 50 consecutive patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration with a 21-G needle and a 25-G needle for a total of 100 biopsies. The study slides were examined by a dedicated lung cytopathologist, who was blinded to the needle size used for each slide. Demographic data, and lymph node size were recorded. Comparisons between the 2 needles with regards to sample adequacy and diagnostic yield was performed using the McNemar test for dichotomous variables and marginal homogeneity test for nondichotomous variables since samples were related.Results: The majority of lymph nodes (96%) were at least > 1 cm. Adequate specimens were obtained in 78% of cases with the 21-G needle and 86% of cases with 25-G needle (P-value = 0.424). The overall diagnostic yield was 74% and 80% with the 21-G needle and 25-G needle, respectively (P-value = 0.607). Conclusion:Our study demonstrates that the there is no difference in terms of specimen adequacy and diagnostic yield when the 25-G needle is compared with the 21-G needle.

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Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations

Mohan,

Madan,

Hadda

et al. 2023

Lung India

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Utility of a 25- Versus 22-G EBUS Needle in Difficult-to-Access 2R Lymph Nodes

Cited by 3 publications

References 2 publications

Clinical validity of 25-gauge endobronchial ultrasound-guided transbronchial needle in lymph node staging of lung cancer

Clinical validity of 25-gauge endobronchial ultrasound-guided transbronchial needle in lymph node staging of lung cancer

Comparison of Sample Adequacy and Diagnostic Yield of the 21-G and 25-G EBUS TBNA Needles

Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations

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