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Roberto F. Casal, MD; Carlos A. Jimenez, MD; Graciela M. Nogueras-Gonzalez, MPH; Rodolfo C. Morice, MD
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From the Department of Pulmonary and Critical Care Medicine (Dr Casal), Michael E. DeBakey VA Medical Center, Baylor College of Medicine; the Department of Pulmonary Medicine (Drs Jimenez and Morice), and the Department of Biostatistics (Ms Nogueras-Gonzalez), The University of Texas MD Anderson Cancer Center.

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


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.

Financial disclosures: The authors have reported to CHEST that no potential conflicts of interests 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(2):584-585. doi:10.1378/chest.12-2631
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To the Editor:

We thank Dr Gould for his comments regarding our study of endobronchial ultrasound performed with and without aspiration.1 One of his main concerns is the denomination of “randomized clinical trial” that we gave to our study. There was, indeed, a randomization used in our study. Of note, instead of randomizing patients or lymph nodes (LNs) to one technique or another, we preferred to use both techniques in each LN and randomize the order in which they would be performed. This way, each LN would provide its own control, and, additionally, this type of randomization would prevent the first-pass bias. We call the first-pass bias the fact that the first sample, in our experience, provides the best quality material, since the LN has not been traumatized by the needle yet.

Dr Gould also points out that our unit of analysis differed from our unit of randomization, with which we agree. However, we do not think this has introduced any bias, since the number of LNs included in each randomization group and the LN size—probably one of the most important factors affecting yield—were comparable. In 98 LNs, passes one to three were performed without suction and two to four with suction; in 94 LNs, passes one to three were performed with suction and two to four without. Lymph node size in short axis (mean ± SD) was 10.45±5.15 mm for LNs in which the initial pass was performed without suction vs 11.65±5.82 mm for LNs in which the initial pass was performed with suction (P =.15).

Regarding Dr Gould’s question about the baseline characteristics of participants in each group, we did not report them separately because all patients and LNs had both techniques performed, serving as their own controls. Patient and LN characteristics of the entire study population were described in Table 1 of our article.1

Acknowledgments

Role of sponsors: Funding from the sponsor was only utilized for statistical support, with no role in study design, data analyses, or writing of this manuscript.

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]
 

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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]
 
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