TY - JOUR
T1 - Stylet Use Does Not Improve Diagnostic Outcomes in Endobronchial Ultrasonographic Transbronchial Needle Aspiration
T2 - A Randomized Clinical Trial
AU - Scholten, Eric L.
AU - Semaan, Roy
AU - Illei, Peter
AU - Mallow, Christopher
AU - Arias, Sixto
AU - Feller-Kopman, David
AU - Oakjones-Burgess, Karen
AU - Frimpong, Bernice
AU - Ortiz, Ricardo
AU - Lee, Hans
AU - Yarmus, Lonny
N1 - Publisher Copyright:
© 2016 American College of Chest Physicians
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background Endobronchial ultrasonographically guided transbronchial needle aspiration (EBUS-TBNA) of thoracic structures is a commonly performed tissue sampling technique. The use of an inner-stylet in the EBUS needle has never been rigorously evaluated and may be unnecessary. Methods In a prospective randomized single-blind controlled clinical trial, patients with a clinical indication for EBUS-TBNA underwent lymph node sampling using both with-stylet and without-stylet techniques. Sample adequacy, diagnostic yield, and various cytologic quality measures were compared. Results One hundred twenty-one patients were enrolled, with 194 lymph nodes sampled, each using both with-stylet and without-stylet techniques. There was no significant difference in sample adequacy or diagnostic yield between techniques. The without-stylet technique resulted in adequate samples in 87% of the 194 study lymph nodes, which was no different from the with-stylet adequacy rate (82%; P = .371). The with-stylet technique resulted in a diagnosis in 50 of 194 samples (25.7%), which was similar to the without-stylet group (49 of 194 [25.2%]; P = .740). There was a high degree of concordance in the determination of adequacy (84.0%; 95% CI, 78.1-88.9) and diagnostic sample generation (95.4%; 95% CI, 91.2-97.9) between the two techniques. A similar qualitative number of lymphocytes, malignant cells, and bronchial respiratory epithelia were recovered using each technique. Conclusions Omitting stylet use during EBUS-TBNA does not affect diagnostic outcomes and reduces procedural complexity. Trial Registry ClinicalTrials.Gov: No. NCT 02201654; URL:www.clinicaltrials.gov.
AB - Background Endobronchial ultrasonographically guided transbronchial needle aspiration (EBUS-TBNA) of thoracic structures is a commonly performed tissue sampling technique. The use of an inner-stylet in the EBUS needle has never been rigorously evaluated and may be unnecessary. Methods In a prospective randomized single-blind controlled clinical trial, patients with a clinical indication for EBUS-TBNA underwent lymph node sampling using both with-stylet and without-stylet techniques. Sample adequacy, diagnostic yield, and various cytologic quality measures were compared. Results One hundred twenty-one patients were enrolled, with 194 lymph nodes sampled, each using both with-stylet and without-stylet techniques. There was no significant difference in sample adequacy or diagnostic yield between techniques. The without-stylet technique resulted in adequate samples in 87% of the 194 study lymph nodes, which was no different from the with-stylet adequacy rate (82%; P = .371). The with-stylet technique resulted in a diagnosis in 50 of 194 samples (25.7%), which was similar to the without-stylet group (49 of 194 [25.2%]; P = .740). There was a high degree of concordance in the determination of adequacy (84.0%; 95% CI, 78.1-88.9) and diagnostic sample generation (95.4%; 95% CI, 91.2-97.9) between the two techniques. A similar qualitative number of lymphocytes, malignant cells, and bronchial respiratory epithelia were recovered using each technique. Conclusions Omitting stylet use during EBUS-TBNA does not affect diagnostic outcomes and reduces procedural complexity. Trial Registry ClinicalTrials.Gov: No. NCT 02201654; URL:www.clinicaltrials.gov.
KW - EBUS-TBNA
KW - interventional bronchoscopy
KW - pathology
KW - stylet
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U2 - 10.1016/j.chest.2016.10.005
DO - 10.1016/j.chest.2016.10.005
M3 - Article
C2 - 27769775
AN - SCOPUS:85014542734
SN - 0012-3692
VL - 151
SP - 636
EP - 642
JO - CHEST
JF - CHEST
IS - 3
ER -