Research Article
Akash Verma, John Abishegan
Abstract
Aim: The optimum number of revolutions (back and forth movement of the needle inside the lymph node) during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) remains to be determined. This study aimed to compare the performance of number of revolutions during EBUS-TBNA of mediastinal and hilar lymph nodes. Methods: Prospective analysis of consecutive patients with mediastinal and hilar lymphadenopathy who underwent EBUS-TBNA over a 3-month period was done. Cytological or histological results from the specimen obtained using two revolutions were compared with 16 revolutions. Results: Twenty four patients underwent sampling of 37 lymph node stations. No difference in the detection rate of the malignancy was noted between lymph node aspiration using 2 versus 16 revolutions (p=0.058). This lack of difference was maintained whether the “worm like” string of core tissue was obtained or not (p=0.08). Although the “worm like” string of core tissue was obtained significantly more frequently with 16 revolutions (p=0.0104), this did not influence the detection rate of malignancy. The average time taken from the start of the procedure to the completion of two revolutions was 11.8 ± 5.6 minutes. Conclusion: More than two revolutions or “worm like” string of aspirate does not add value in diagnosing malignancy via EBUS-TBNA. In patients with high pre-test probability of lung cancer, adequacy of two revolutions may confer greater safety and efficiency to the procedure. However, in case of high suspicion of a benign disease, it may be preferable to seek “worm like” material to aid establishment of diagnosis.