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Original Research |

Stylet Usage Does Not Improve Diagnostic Outcomes in Endobronchial Ultrasound 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; Bernice Frimpong; Ricardo Ortiz; Hans Lee, MD; Lonny Yarmus, DO
Author and Funding Information

Conflicts of interest: None of the authors listed above have any relevant conflicts of interests

Funding Information: Not applicable

Notation of prior abstract presentation: preliminary data from this study was presented as a poster at the annual American Thoracic Society meeting in Denver, CO in 2015.

1Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego School of Medicine, La Jolla, CA

2Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

3Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD

4Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami, Miller School of Medicine, Miami, FL

Corresponding Author Information: Dr. Lonny Yarmus Associate Professor of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street 5th Floor Baltimore, MD, 21287.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.005
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Abstract

Background  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.

Methods  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.

Results  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.

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


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