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Endobronchial Ultrasound-Guided Transbronchial Needle AspirationEndobronchial Ultrasound Needles: One Defect Away From Perfect FREE TO VIEW

Gian Luca Casoni, MD; Carlo Gurioli, MD; Claudia Ravaglia, MD; Christian Gurioli, MD; Venerino Poletti, MD
Author and Funding Information

From the Department of Diseases of the Thorax, Morgagni-Pierantoni Hospital.

Correspondence to: Gian Luca Casoni, MD, Department of Diseases of the Thorax, Morgagni-Pierantoni Hospital, Forli, Italy; e-mail: casonig1970@libero.it


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(1):265. doi:10.1378/chest.11-0117
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To the Editor:

In a recent issue of CHEST (January 2011), Gounant et al1 showed that dedicated linear echoendoscope endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needles are able to release metal particles, probably by friction between the stylet and the needle, with a potential risk of injecting particles into nodes. After reading this article, we are a bit confused for several reasons.

First, we do not understand the primum movens and the intrinsic aim of designing a study like this. Logically, we should perform similar investigations on all surgical, endoscopic, and radiologic procedures in which metal tools are used. Indeed, a simple blood test with a needle could release metal particles. Therefore, we do not understand the need to focus specifically on dedicated EBUS-TBNA needles.

Second, the article does not indicate the concentrations of iron, titanium, nickel, and chromium that can be potentially harmful to the body. This is important information, considering how many times a patient may undergo EBUS-TBNA over a lifetime (one, maybe two times). Accordingly, we have some doubts that the concentrations released in the lymph nodes are so high as to be potentially harmful to the body.

In conclusion, we completely agree with the authors that transbronchial needle aspiration using a flexible bronchoscope (conventional transbronchial needle aspiration) or linear echoendoscope (endobronchial ultrasound) allowing real-time guided lymph node aspiration are minimally invasive procedures for the diagnosis of mediastinal lymphadenopathy, with a very high sensitivity, a very low morbidity, and no reported mortality.2,3 Although the release of metal particles by an EBUS-TBNA needle may be reported to the manufacturers of these needles, this must not lead to a reduction in, or questioning of, the use of EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy.

Gounant V, Ninane V, Janson X, et al. Release of metal particles from needles used for transbronchial needle aspiration. Chest. 2011;1391:138-143. [CrossRef] [PubMed]
 
Holty JE, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax. 2005;6011:949-955. [CrossRef] [PubMed]
 
Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J. 2009;335:1156-1164. [CrossRef] [PubMed]
 

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References

Gounant V, Ninane V, Janson X, et al. Release of metal particles from needles used for transbronchial needle aspiration. Chest. 2011;1391:138-143. [CrossRef] [PubMed]
 
Holty JE, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax. 2005;6011:949-955. [CrossRef] [PubMed]
 
Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J. 2009;335:1156-1164. [CrossRef] [PubMed]
 
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