Pulmonary & Respiratory Medicine

EBUS-TBNA: Are Two Needle Revolutions (Back and Forth Movement of the Needle Inside the Lymph Node) Adequate for Diagnosis of Lung Cancer?

Abstract

Akash Verma, John Abisheganaden, Poh Wee Teng, Kent Mancer and Eric S. Edell

Aim: The optimum number of revolutions (back and forth movement of the needle inside the lymph node) during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) remains to be determined. This study aimed to compare the performance of number of revolutions during EBUS-TBNA of mediastinal and hilar lymph nodes.

Methods: Prospective analysis of consecutive patients with mediastinal and hilar lymphadenopathy who underwent EBUS-TBNA over a 3-month period was done. Cytological or histological results from the specimen obtained using two revolutions were compared with 16 revolutions.

Results: Twenty four patients underwent sampling of 37 lymph node stations. No difference in the detection rate of the malignancy was noted between lymph node aspiration using 2 versus 16 revolutions (p=0.058). This lack of difference was maintained whether the “worm like” string of core tissue was obtained or not (p=0.08). Although the “worm like” string of core tissue was obtained significantly more frequently with 16 revolutions (p=0.0104), this did not influence the detection rate of malignancy. The average time taken from the start of the procedure to the completion of two revolutions was 11.8 ± 5.6 minutes.

Conclusion: More than two revolutions or “worm like” string of aspirate does not add value in diagnosing malignancy via EBUS-TBNA. In patients with high pre-test probability of lung cancer, adequacy of two revolutions may confer greater safety and efficiency to the procedure. However, in case of high suspicion of a benign disease, it may be preferable to seek “worm like” material to aid establishment of diagnosis.

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