Endobronchial Ultrasound Guided Transbronchial Needle Aspiration vs. Traditional Needle Tissue Acquisition in the Age of Cytogenetics

Excerpts from Roshen Mathew, MD; Chirag Shah, MD; Maria del Mar Cirino-Marcano, MD; Sean Stoy, MDAECOM, Montefiore Medical Center, Bronx, NY

Chest. 2015;148(4_MeetingAbstracts):827A. doi:10.1378/chest.2221682

PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is traditionally performed to acquire tissue from mediastinal and hilar nodes. It is unknown if core biopsy needles for EBUS-TBNA are comparable to traditional needles.

METHODS: Retrospective review of 159 EBUS-TBNA cases performed with rapid onsite evaluation (ROSE) using either a standard Mediglobe SonoTip II EBUS 22G needle (MGE), or a Cook Echotip Procore (22/25G) EBUS needle with core biopsy capability at a tertiary care medical center between 2013 and 2014. 

Data was evaluated for adequacy of cytology specimens during ROSE, final yield for cytopathology via FNA and cellblock, blood contamination, and yield of the TBNA specimen for the ability to test for lung cancer cytogenetics.

RESULTS: Mean age and sex were not statistically significant. Ethnic group distribution was African American (31%), White (21%) and Hispanic (41%) other groups (7%). Regarding ROSE - with MGE 30 (34%) vs PCE 59 (66%) had satisfactory specimens during assessment.  Other parameters comparison we summarize in the below table.

CONCLUSIONS: The Cook Procore needle for EBUS-TBNA demonstrated improved yield over a standard needle in testing for malignancy, providing satisfactory material for ROSE, along with providing sufficient material for lung cancer cytogenetics.

CLINICAL IMPLICATIONS: EBUS-TBNA is the first modern choice for mediastinal diagnostics and staging for potential malignancy. At our center, the data supports utilizing a core needle instead of a traditional needle to safely acquire tissue for cytopathology and cytogenetic analyses.