From the Department of Pulmonary Medicine and Thoracic Oncology (Dr Dhillon), Roswell Park Cancer Institute, and Department of Pulmonary, Critical Care and Sleep Medicine (Dr Berim), State University of New York at Buffalo.
Correspondence to: Samjot S. Dhillon, MD, FCCP, Department of Pulmonary Medicine and Thoracic Oncology, Roswell Park Cancer Institute, Elm and Carlton St, Buffalo, NY 14263; e-mail: Samjot.Dhillon@roswellpark.org
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Dhillon received a Roswell Park Alliance Grant of $30,900 to study vitamin D levels in patients with COPD and a high risk for lung cancer. Dr Berim has reported 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).
© 2012 American College of Chest Physicians
Release of metal particles into endobronchial ultrasound-guided transbronchial needle aspiration specimens by proprietary Olympus ViziShot needles (Olympus Ltd) has been demonstrated recently by Gounant et al1 in a recent issue of CHEST (January 2011). Introduction of the same into mediastinal lymph nodes being sampled also appears to be likely. However, the mechanism and clinical significance of such a phenomenon remains unclear.2 Friction between the stylet and needle has been proposed as a potential source of metallic particulate matter production.
We appreciate the effort of the researchers to look into the cause of excess dark metallic material noted on specimens, and we would like to share our experience. Several months ago, we started cleaning the stylet of the Olympus ViziShot needles with wet gauze during our procedures. We believed that a small amount of clotted blood in the working channel of the needle assembly was responsible for the progressive increase in resistance encountered during the insertion and removal of the stylet during procedures. We were surprised to see dark particles on the wet gauze mixed with small amounts of blood during several of our cases. Even when we cleaned the stylet before the procedure, a significant amount of dark material was seen on the gauze (Fig 1). This suggests that such particulate matter was present even prior to procedure initiation and could be due to friction between the stylet and the channel in the needle assembly unless it is some coating or lubricant on the stylet itself. We have also notified Olympus of these findings. Although the exact significance and clinical implications of these findings is not yet clear, they are clearly abnormal and are usually not seen with surgical instruments during other procedures. We applaud the authors for carefully studying this and bringing it to attention and hope that some minor changes in design many result in remediation of this concern.
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