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Pulmonary Procedures |

ProCore Needles Versus Standard 22-Gauge Needle in EBUS Guided Biopsies FREE TO VIEW

Margaret Zambon, MD; Rajeswari Nagarathinam, MBBS; Donna Russell, MEd; Ellen Giampoli, MD; Michael Nead, MD
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University of Rochester Medical Center, Rochester, NY


Chest. 2015;148(4_MeetingAbstracts):791A. doi:10.1378/chest.2281188
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Abstract

SESSION TITLE: EBUS and Image-Guided Bronchoscopy

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM

PURPOSE: Endobronchial ultrasound guided sampling of lymph nodes provides excellent results but with yields short of 100%. Immunohistochemical and mutation analysis necessitates larger amounts of tissue, and accurately diagnosing lymphoma often requires tissue architecture. Newer EBUS needles are available that enable core samples to be obtained. We hypothesized that EBUS directed core biopsies would provide better samples for diagnosis than biopsies performed with a standard EBUS needle.

METHODS: A total of 19 patients underwent biopsy with both a standard 22g EBUS needle as well as either a 22g or a 25g ProCore needle, or both in one case. The ProCore needle was used if rapid onsite evaluation did not have diagnostic material after the first lymph node was biopsied. Samples were retrospectively reviewed for diagnostic yield and analyzed according to Mair’s criteria for five sample characteristics (background clot, amount of cellular material, cellular degeneration, cellular trauma, and retention of structure). Final diagnosis was based on chart review over 12 months from biopsy.

RESULTS: EBUS reached a diagnosis in 17/19 cases (89%), with the remaining cases being sarcoidosis and undiagnosed but stable nodes. The same diagnosis was reached with both needles in 13/19 cases (68%), with the ProCore alone in 3/19, and the standard needle alone in 1/19. The mean difference in Mair’s criteria between the combined ProCore needle types and conventional needle is 0.632 favoring the ProCore needles. There was no difference in the Mair criteria between the 25g ProCore and the standard needle, while the difference between the 22g ProCore and the standard needle was 0.8.

CONCLUSIONS: The data suggest that the ProCore needles have greater diagnostic strength than the standard 22g needle, specifically the 22g ProCore needle. Diagnostic yield was highest combining the standard and ProCore needles, and use of the standard needle alone would have missed the diagnosis in three cases. However, the Mair criteria difference did not meet statistical significance (p=0.473) for sample characteristics. Larger prospective studies are necessary before any definite conclusions can be drawn.

CLINICAL IMPLICATIONS: This study describes performance of the newer ProCore needles relative to the standard 22g needle and could guide bronchoscopists in needle selection for their cases.

DISCLOSURE: Margaret Zambon: Other: ProCore needles were provided free of charge for a trial by Cook. They had no influence on the study, its design, or even the fact a study was being done. Rajeswari Nagarathinam: Other: ProCore needles were provided free of charge for a trial by Cook. They had no influence on the study, its design, or even the fact a study was being done. Donna Russell: Other: ProCore needles were provided free of charge for a trial by Cook. They had no influence on the study, its design, or even the fact a study was being done. Ellen Giampoli: Other: ProCore needles were provided free of charge for a trial by Cook. They had no influence on the study, its design, or even the fact a study was being done. Michael Nead: Other: ProCore needles were provided free of charge for a trial by Cook. They had no influence on the study, its design, or even the fact a study was being done.

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