Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of thoracic structures is a commonly performed tissue sampling technique. The usage of an inner-stylet in the EBUS needle has never been rigorously evaluated, and may be unnecessary.
In a prospective randomized single blinded 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 cytological quality measures were compared.
121 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 than the with-stylet adequacy rate (82%, P =0.371). The with-stylet technique resulted in a diagnosis in 50/194 samples (25.7%) similar to the without-stylet group (49/194, 25.2%, P =0.740). 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 amount of lymphocytes, malignant cells and bronchial respiratory epithelium were recovered using each technique.
Omitting stylet usages during EBUS-TBNA does not affect diagnostic outcomes and reduces procedural complexity.