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Original Research: Pulmonary Procedures |

Randomized Clinical Trial of Endobronchial Ultrasound Needle Biopsy With and Without AspirationEndobronchial Ultrasound With and Without Suction

Roberto F. Casal, MD; Gregg A. Staerkel, MD; David Ost, MD, FCCP; Francisco A. Almeida, MD, FCCP; Mateen H. Uzbeck, MD; George A. Eapen, MD, FCCP; Carlos A. Jimenez, MD, FCCP; Graciela M. Nogueras-Gonzalez, MPH; Mona Sarkiss, MD, PhD; Rodolfo C. Morice, MD, FCCP
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine (Dr Casal), Michael E. DeBakey VA Medical Center, Baylor College of Medicine; the Department of Pathology (Dr Staerkel), Division of Anatomic Pathology and Laboratory Medicine; the Department of Pulmonary Medicine (Drs Ost, Uzbeck, Eapen, Jimenez, and Morice); the Department of Biostatistics (Ms Nogueras-Gonzalez); and the Department of Anesthesiology and Perioperative Medicine (Dr Sarkiss), The University of Texas MD Anderson Cancer Center, Houston, TX; and the Department of Pulmonary and Critical Care Medicine (Dr Almeida), Cleveland Clinic, Cleveland, OH.

Correspondence to: Roberto F. Casal, MD, Department of Pulmonary and Critical Care Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, 2002 Holcombe Blvd, Pulmonary Section 111i, Houston, TX 77030; e-mail: casal@bcm.edu


For editorial comment see page 551

Funding/Support: This research was supported in part by the National Institutes of Health through a Cancer Center Support Grant [Grant CA016672] to The University of Texas MD Anderson Cancer Center.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(3):568-573. doi:10.1378/chest.11-0692
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Background:  Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (EBUS-TBNA) is performed with a dedicated 22- or 21-gauge needle while suction is applied. Fine-needle sampling without suction (capillary sampling) has been studied for endoscopic ultrasound and for biopsies at various body sites and has resulted in similar diagnostic yield and fewer traumatic samples. However, the role of EBUS-guided transbronchial needle capillary sampling (EBUS-TBNCS) is still to be determined.

Methods:  Adults with suspicious hilar or mediastinal lymph nodes (LNs) were included in a single-blinded, prospective, randomized trial comparing EBUS-TBNA and EBUS-TBNCS. The primary end point was the concordance rate between the two techniques in terms of adequacy and diagnosis of cytologic samples. The secondary end point was the concordance rate between the two techniques in terms of quality of samples.

Results:  A total of 115 patients and 192 LNs were studied. Concordance between EBUS-TBNA and EBUS-TBNCS was high, with no significant difference in adequacy (88% vs 88%, respectively [P ± .858]; concordance rate, 83.9% [95% CI, 77.9-88.8]); diagnosis (36% vs 34%, respectively [P ± .289]; concordance rate, 95.8% [95% CI, 92-92.8]); diagnosis of malignancy (28% vs 26%, respectively [P ± .125]; concordance rate, 97.9% [95% CI, 94.8-99.4]); or sample quality (concordance rate, 83.3% [95% CI, 73.3-88.3]). Concordance between EBUS-TBNA and EBUS-TBNCS was high irrespective of LN size (≤ 1 cm vs . 1 cm).

Conclusions:  Regardless of LN size, no differences in adequacy, diagnosis, or quality were found between samples obtained using EBUS-TBNA and those obtained using EBUS-TBNCS. There is no evidence of any benefit derived from the practice of applying suction to EBUS-guided biopsies.

Trial registry:  ClinicalTrials.gov; No.: NCT00886847; URL: www.clinicaltrials.gov

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