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Endobronchial Ultrasound Needle Biopsy With and Without AspirationNeedle Biopsy With and Without Aspiration: The “Core” Issue FREE TO VIEW

Karan Madan, MD, DM; Randeep Guleria, MD, DM
Author and Funding Information

From the Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences.

Correspondence to: Karan Madan, MD, DM, Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India; e-mail: drkaranmadan@gmail.com


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. See online for more details.


Chest. 2013;143(1):281-282. doi:10.1378/chest.12-2239
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To the Editor:

We read with keen interest the article by Casal et al1 in a recent issue of CHEST (September 2012). The authors reported on the use of endobronchial ultrasound (EBUS)-guided transbronchial needle capillary sampling, a technique that has not been previously evaluated for EBUS-guided transbronchial needle aspiration.

The authors reported no benefit derived from the practice of applying suction to EBUS-guided biopsies. However, a very important issue not highlighted in the article is that of a differential yield of histologic core obtained between the aspiration and no aspiration groups. The utility of tissue core that can be subjected to detailed histopathologic analysis has been highlighted multiple times previously.2-4 Lee et al2 reported that when at least one tissue core was obtained during the first or second aspirations, then the sensitivity, negative predictive value, and diagnostic accuracy were significantly higher and that the number of passes for optimal mediastinal staging in lung cancer could be reduced from three to two. Additionally, samples with tissue cores were nearly 20% more likely to be adequate for evaluation than aspirates without tissue cores. Histologic cores are also very useful for performing genetic and molecular analyses.3

It would be important to know whether the yield of histologic cores was addressed by the authors in the present study. Another point is that attaching the vacuum suction syringe to the needle hardly adds to the procedure duration, whereas performing an additional needle pass surely does. Therefore, in our opinion, the study does not generate adequate evidence to give up the practice of applying suction during EBUS-guided transbronchial needle aspiration. This would require a larger study in which all the histopathologic tissue yield issues are addressed and the yield of tissue cores can be demonstrated to be equal to EBUS-guided transbronchial needle capillary sampling and conventional aspiration with suction.

References

Casal RF, Staerkel GA, Ost D, et al. Randomized clinical trial of endobronchial ultrasound needle biopsy with and without aspiration. Chest. 2012;142(3):568-573. [CrossRef] [PubMed]
 
Lee HS, Lee GK, Lee H-S, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-374. [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K, Suzuki M, et al. Assessment of epidermal growth factor receptor mutation by endobronchial ultrasound-guided transbronchial needle aspiration. Chest. 2007;132(2):597-602. [CrossRef] [PubMed]
 
Yasufuku K, Chiyo M, Sekine Y, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-128. [CrossRef] [PubMed]
 

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References

Casal RF, Staerkel GA, Ost D, et al. Randomized clinical trial of endobronchial ultrasound needle biopsy with and without aspiration. Chest. 2012;142(3):568-573. [CrossRef] [PubMed]
 
Lee HS, Lee GK, Lee H-S, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-374. [CrossRef] [PubMed]
 
Nakajima T, Yasufuku K, Suzuki M, et al. Assessment of epidermal growth factor receptor mutation by endobronchial ultrasound-guided transbronchial needle aspiration. Chest. 2007;132(2):597-602. [CrossRef] [PubMed]
 
Yasufuku K, Chiyo M, Sekine Y, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-128. [CrossRef] [PubMed]
 
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