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Original Research: Pulmonary Procedures |

Stylet Use Does Not Improve Diagnostic Outcomes in Endobronchial Ultrasonographic Transbronchial Needle Aspiration: A Randomized Clinical Trial

Eric L. Scholten, MD; Roy Semaan, MD; Peter Illei, MD; Christopher Mallow, MD; Sixto Arias, MD; David Feller-Kopman, MD; Karen Oakjones-Burgess, BSN; Bernice Frimpong, BS; Ricardo Ortiz, BS; Hans Lee, MD; Lonny Yarmus, DO
Author and Funding Information

Drs Scholten and Semaan are co-first authors and contributed equally to this work.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDivision of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego School of Medicine, La Jolla, CA

bSection of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

cDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD

dDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami, Miller School of Medicine, Miami, FL

CORRESPONDENCE TO: Lonny Yarmus, DO, Johns Hopkins University School of Medicine, 1830 East Monument St, 5th Floor, Baltimore, MD, 21287


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(3):636-642. doi:10.1016/j.chest.2016.10.005
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Background  Endobronchial ultrasonographically guided transbronchial needle aspiration (EBUS-TBNA) of thoracic structures is a commonly performed tissue sampling technique. The use of an inner-stylet in the EBUS needle has never been rigorously evaluated and may be unnecessary.

Methods  In a prospective randomized single-blind controlled clinical trial, patients with a clinical indication for EBUS-TBNA underwent lymph node sampling using both with-stylet and without-stylet techniques. Sample adequacy, diagnostic yield, and various cytologic quality measures were compared.

Results  One hundred twenty-one patients were enrolled, with 194 lymph nodes sampled, each using both with-stylet and without-stylet techniques. There was no significant difference in sample adequacy or diagnostic yield between techniques. The without-stylet technique resulted in adequate samples in 87% of the 194 study lymph nodes, which was no different from the with-stylet adequacy rate (82%; P = .371). The with-stylet technique resulted in a diagnosis in 50 of 194 samples (25.7%), which was similar to the without-stylet group (49 of 194 [25.2%]; P = .740). There was a high degree of concordance in the determination of adequacy (84.0%; 95% CI, 78.1-88.9) and diagnostic sample generation (95.4%; 95% CI, 91.2-97.9) between the two techniques. A similar qualitative number of lymphocytes, malignant cells, and bronchial respiratory epithelia were recovered using each technique.

Conclusions  Omitting stylet use during EBUS-TBNA does not affect diagnostic outcomes and reduces procedural complexity.

Trial Registry  ClinicalTrials.Gov: No. NCT 02201654; URL:www.clinicaltrials.gov.

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