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Valérie Gounant, MD; Jocelyne Fleury-Feith, MD, PhD
Author and Funding Information

From the Service de Pneumologie et Réanimation (Dr Gounant), the Service de Chirurgie Thoracique (Dr Gounant), and the Service d’Histologie Biologie Tumorale (Dr Fleury-Feith), Hôpital Tenon, AP-HP, Faculté de Médecine, Université Pierre et Marie Curie; and the Laboratoire d’Etude des Particules Inhalées (Dr Fleury-Feith).

Correspondence to: Valérie Gounant, MD, Service de Pneumologie et Réanimation, Service de Chirurgie Thoracique, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020 Paris, France; e-mail: valerie.gounant@tnn.aphp.fr


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):265-266. doi:10.1378/chest.11-0504
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To the Editor:

We thank Dr Casoni and colleagues for their interest in our recent article published in CHEST (January 2011)1 on the release of metal particles from ViziShot needles (Olympus Ltd; Tokyo, Japan) used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We believe that Dr Casoni et al failed to understand why this study was designed. In fact, transbronchial needle aspiration (conventional and endobronchial ultrasound-guided) was introduced in our respiratory disease center in 2007, and we very rapidly became intrigued by the deposition of foreign material on slides prepared for cytopathologic examination. This is a very unusual finding. Many specimens are examined each day in the cytopathology laboratory, and such deposits had never been previously observed, regardless of the type of needle used for sampling (eg, pleural, peritoneal, or cerebrospinal fluids; peripheral lymph node or skin nodule; transthoracic needle aspiration). This study was designed to define the nature of this foreign material and to identify its origin. The blind review of 141 cytospins clearly demonstrated that particles were only observed on EBUS-TBNA samples and not on conventional transbronchial needle aspiration samples. We, therefore, focused our investigations specifically on ViziShot needles, as these particles may interfere with pathologic interpretation by cytopathologists (false diagnosis of anthracosis), and we also wanted to find a scientific explanation for these findings. This study confirmed that the particles released were metal alloys used in the manufacture of the needles (iron, titanium, nickel, and chromium) and that these EBUS-TBNA ViziShot needles are potential contaminators of aspirated lymph nodes. The hypothesis of poor quality control was proposed, especially because, at the time of the study, these needles were the only dedicated EBUS-TBNA needles available.

In addition, Dr Casoni and colleagues underline that metal particle concentrations are not indicated in the article. We agree that data on metal particle concentrations would be important when discussing potential adverse effects; however, all tested needles were washed with the same volume (2 mL) of distilled water prior to mineral analysis, and the density of particles observed on the grids was, therefore, correlated to the amount of particles released by the needles. However, the metal particle concentration is not the only parameter involved in the potential impact on health: The size of the particles; their chemical composition, shape, and surface; and the fact that they penetrate directly into the node without being phagocytosed by alveolar macrophages (as in the case of inhaled particles) must also be taken into account.2 The particles observed on light microscopy examination of the samples were 0.64 to 5.33 μm long, but could consist of aggregates of finer particles. On electron microscopy examination, the isolated particles measured 0.2 to 0.5 μm and were classified into fine to ultrafine particles. Fine and ultrafine particles are not only directly toxic but also are known to induce immunoallergic reactions not necessarily correlated to the quantity of particles.3 Publications on sarcoidosis have suggested the possible involvement of particles as a cause of the disease,4,5 and the potential risk of granulomatous reactions must be considered. In conclusion, although the health consequences of the release of metal particles by one type of dedicated EBUS-TBNA needle is a subject of debate, it seemed important to inform the medical community about this risk in order to discuss potential medical implications and for health administrators to assume their responsibilities.

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]
 
Oberdörster G, Oberdörster E, Oberdörster J. Nanotoxicology: an emerging discipline evolving from studies of ultrafine particles. Environ Health Perspect. 2005;1137:823-839. [CrossRef] [PubMed]
 
Granum B, Løvik M. The effect of particles on allergic immune responses. Toxicol Sci. 2002;651:7-17. [CrossRef] [PubMed]
 
Kim YC, Triffet MK, Gibson LE. Foreign bodies in sarcoidosis. Am J Dermatopathol. 2000;225:408-412. [CrossRef] [PubMed]
 
Heffner DK. The cause of sarcoidosis: the Centurial enigma solved. Ann Diagn Pathol. 2007;112:142-152. [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]
 
Oberdörster G, Oberdörster E, Oberdörster J. Nanotoxicology: an emerging discipline evolving from studies of ultrafine particles. Environ Health Perspect. 2005;1137:823-839. [CrossRef] [PubMed]
 
Granum B, Løvik M. The effect of particles on allergic immune responses. Toxicol Sci. 2002;651:7-17. [CrossRef] [PubMed]
 
Kim YC, Triffet MK, Gibson LE. Foreign bodies in sarcoidosis. Am J Dermatopathol. 2000;225:408-412. [CrossRef] [PubMed]
 
Heffner DK. The cause of sarcoidosis: the Centurial enigma solved. Ann Diagn Pathol. 2007;112:142-152. [CrossRef] [PubMed]
 
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