Journal Article

Flexible 19-Gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Needle: First Experience

Herth, Felix J.F., Gompelmann, Daniela, Eberhardt, Ralf, Patel, Priya, MacEachern, Paul, Hergott, Christopher A., Tremblay, Alain, Fortin, Marc, Kemp, Samuel V., Shah, Pallav L., Dumoulin, Elaine, Czarnecka, Kasia, Tyan, Chung, Yasufuku, Kazuhiro

2017

Overview

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established first-line invasive modality for mediastinal lymph node staging in lung cancer patients and in the diagnostic workup of patients with mediastinal adenopathy. With the current 21- and 22-gauge (G) EBUS-TBNA needles, the procedure can be limited by the degree of flexibility in the needle and the size of the lumen in tissue acquisition. Objective: We report our initial experience with a first-generation flexible 19-G EBUS-TBNA (Flex 19G; Olympus Respiratory America, Redmond, WA, USA) needle with regards to efficacy and safety. Methods: The Flex 19G EBUS-TBNA needle was used in 47 selected patients with enlarged hilar and/or mediastinal lymphadenopathy at 3 centers. The standard Olympus EBUS scope with a 2.2-mm working channel was used in all cases. Results: The diagnostic yield of the Flex 19G needle according to clinical cytopathology reports was 89% (42/47). The diagnosis and their respective diagnostic yield with the Flex 19G EBUS-TBNA needle were malignancy 24/27 (89%), sarcoidosis 13/14 (93%), and reactive lymph node hyperplasia 5/6 (83%). The mean short axis of the sampled lymph nodes was 19 ± 9 mm. No complications occurred except for 1 instance of moderate bleeding, which did not require intervention beyond suctioning and subsequently resolved. All 13 patients diagnosed with adenocarcinoma by the 19-G needle had sufficient tissue for genetic testing. Conclusion: EBUS-TBNA using the first-generation Flex 19G needle is feasible and safe with promising diagnostic yield while providing a greater degree of flexion with the Olympus EBUS scope. Additional clinical evaluations are warranted.

• Publisher: S. Karger AG
• Subject: Adenocarcinoma - diagnosis / Adenocarcinoma - pathology / Adenocarcinoma of Lung / Aged / Biopsy / Biopsy, Needle / Bronchoscopy / Carcinoma, Squamous Cell - diagnosis / Carcinoma, Squamous Cell - pathology / Diagnosis / Endoscopic ultrasonography / Endoscopic Ultrasound-Guided Fine Needle Aspiration - instrumentation / Female / Humans / Interventional Pulmonology / Lung cancer / Lung Neoplasms - diagnosis / Lung Neoplasms - pathology / Lymph nodes / Lymph Nodes - pathology / Lymphadenopathy - pathology / Lymphoma - diagnosis / Lymphoma - pathology / Male / Mediastinal Neoplasms - diagnosis / Mediastinal Neoplasms - pathology / Mediastinum / Methods / Middle Aged / Needles / Neoplasms - diagnosis / Neoplasms - pathology / Pseudolymphoma - diagnosis / Pseudolymphoma - pathology / Retrospective Studies / Sarcoidosis, Pulmonary - diagnosis / Sarcoidosis, Pulmonary - pathology / Small Cell Lung Carcinoma - diagnosis / Small Cell Lung Carcinoma - pathology / Tumor staging