Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy

Xiaoxiao Lin, Min Ye, Yuping Li, Jing Ren, Qiyan Lou, Yangyang Li, Xiaohui Jin, Ko Wang, Chengshui Chen

Research output: Contribution to journalArticle

Abstract

Background: The optimal procedure for maximizing the diagnostic yield and minimizing the procedural complexity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is controversial. We conducted a prospective randomized controlled trial to determine the optimal procedure of EBUS-TBNA for mediastinal and hilar lymphadenopathy, with a particular focus on the roles of the inner-stylet and suction. Methods: Consecutive patients with enlarged mediastinal and hilar lymph nodes (LNs), detected by computed tomography (CT) or positron emission tomography-CT (PET-CT), who underwent EBUS-TBNA were included. Each LN was sampled with three needle passes using suction-stylet, suction-no stylet, and stylet-no suction procedures. The samples were smeared onto glass slides for cytological evaluation. A single, blinded cytopathologist evaluated each set of slides. The primary outcomes were cytological specimen adequacy rate and diagnostic yield of malignant LNs. The secondary outcomes were tissue-core acquisition rate, procedural time, and the amount of bleeding. Results: This study evaluated 97 patients with a total of 255 LNs. The final LN diagnosis was benign in 144, malignant in 104, and inadequate in 7 cases. There were no significant differences among the suction-stylet, suction-no stylet, and stylet-no suction groups in specimen adequacy rate (87.1, 88.2, 85.9%, respectively) or diagnostic yield of malignancy (32.2, 31.8, 31.0%, respectively). However, the use of suction was associated with an increase in tissue-core acquisition rate (P < 0.001). The no-stylet procedure decreased the average procedural time by 14 s (P < 0.001). There was no significant difference in the amount of bleeding among the procedures. Conclusions: The use of suction or non-use of an inner-stylet does not make a significant difference in cytological specimen adequacy or diagnostic yield when performing EBUS-TBNA. While omitting the stylet can simplify the procedure, applying suction can increase the tissue-core acquisition rate. These findings may assist endoscopic physicians in determining the optimal EBUS-TBNA procedure and warrant clinical verification in a future multicentre study. Trial registration: Trial registration: (ChiCTR-IOR-17010616). Retrospective registered date: 12th February, 2017.

Original languageEnglish (US)
Article number192
JournalBMC Pulmonary Medicine
Volume18
Issue number1
DOIs
StatePublished - Dec 7 2018

Fingerprint

Suction
Needles
Randomized Controlled Trials
Lymph Nodes
Lymphadenopathy
Bleeding Time
Multicenter Studies
Glass
Tomography
Hemorrhage
Physicians

Keywords

  • Clinical trial
  • Endobronchial ultrasound-guided transbronchial needle aspiration
  • Lymphadenopathy
  • Malignant

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy. / Lin, Xiaoxiao; Ye, Min; Li, Yuping; Ren, Jing; Lou, Qiyan; Li, Yangyang; Jin, Xiaohui; Wang, Ko; Chen, Chengshui.

In: BMC Pulmonary Medicine, Vol. 18, No. 1, 192, 07.12.2018.

Research output: Contribution to journalArticle

Lin, Xiaoxiao ; Ye, Min ; Li, Yuping ; Ren, Jing ; Lou, Qiyan ; Li, Yangyang ; Jin, Xiaohui ; Wang, Ko ; Chen, Chengshui. / Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy. In: BMC Pulmonary Medicine. 2018 ; Vol. 18, No. 1.
@article{4112743fd68645f8bae2e14b0b3e3560,
title = "Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy",
abstract = "Background: The optimal procedure for maximizing the diagnostic yield and minimizing the procedural complexity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is controversial. We conducted a prospective randomized controlled trial to determine the optimal procedure of EBUS-TBNA for mediastinal and hilar lymphadenopathy, with a particular focus on the roles of the inner-stylet and suction. Methods: Consecutive patients with enlarged mediastinal and hilar lymph nodes (LNs), detected by computed tomography (CT) or positron emission tomography-CT (PET-CT), who underwent EBUS-TBNA were included. Each LN was sampled with three needle passes using suction-stylet, suction-no stylet, and stylet-no suction procedures. The samples were smeared onto glass slides for cytological evaluation. A single, blinded cytopathologist evaluated each set of slides. The primary outcomes were cytological specimen adequacy rate and diagnostic yield of malignant LNs. The secondary outcomes were tissue-core acquisition rate, procedural time, and the amount of bleeding. Results: This study evaluated 97 patients with a total of 255 LNs. The final LN diagnosis was benign in 144, malignant in 104, and inadequate in 7 cases. There were no significant differences among the suction-stylet, suction-no stylet, and stylet-no suction groups in specimen adequacy rate (87.1, 88.2, 85.9{\%}, respectively) or diagnostic yield of malignancy (32.2, 31.8, 31.0{\%}, respectively). However, the use of suction was associated with an increase in tissue-core acquisition rate (P < 0.001). The no-stylet procedure decreased the average procedural time by 14 s (P < 0.001). There was no significant difference in the amount of bleeding among the procedures. Conclusions: The use of suction or non-use of an inner-stylet does not make a significant difference in cytological specimen adequacy or diagnostic yield when performing EBUS-TBNA. While omitting the stylet can simplify the procedure, applying suction can increase the tissue-core acquisition rate. These findings may assist endoscopic physicians in determining the optimal EBUS-TBNA procedure and warrant clinical verification in a future multicentre study. Trial registration: Trial registration: (ChiCTR-IOR-17010616). Retrospective registered date: 12th February, 2017.",
keywords = "Clinical trial, Endobronchial ultrasound-guided transbronchial needle aspiration, Lymphadenopathy, Malignant",
author = "Xiaoxiao Lin and Min Ye and Yuping Li and Jing Ren and Qiyan Lou and Yangyang Li and Xiaohui Jin and Ko Wang and Chengshui Chen",
year = "2018",
month = "12",
day = "7",
doi = "10.1186/s12890-018-0751-0",
language = "English (US)",
volume = "18",
journal = "BMC Pulmonary Medicine",
issn = "1471-2466",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Randomized controlled trial to evaluate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy

AU - Lin, Xiaoxiao

AU - Ye, Min

AU - Li, Yuping

AU - Ren, Jing

AU - Lou, Qiyan

AU - Li, Yangyang

AU - Jin, Xiaohui

AU - Wang, Ko

AU - Chen, Chengshui

PY - 2018/12/7

Y1 - 2018/12/7

N2 - Background: The optimal procedure for maximizing the diagnostic yield and minimizing the procedural complexity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is controversial. We conducted a prospective randomized controlled trial to determine the optimal procedure of EBUS-TBNA for mediastinal and hilar lymphadenopathy, with a particular focus on the roles of the inner-stylet and suction. Methods: Consecutive patients with enlarged mediastinal and hilar lymph nodes (LNs), detected by computed tomography (CT) or positron emission tomography-CT (PET-CT), who underwent EBUS-TBNA were included. Each LN was sampled with three needle passes using suction-stylet, suction-no stylet, and stylet-no suction procedures. The samples were smeared onto glass slides for cytological evaluation. A single, blinded cytopathologist evaluated each set of slides. The primary outcomes were cytological specimen adequacy rate and diagnostic yield of malignant LNs. The secondary outcomes were tissue-core acquisition rate, procedural time, and the amount of bleeding. Results: This study evaluated 97 patients with a total of 255 LNs. The final LN diagnosis was benign in 144, malignant in 104, and inadequate in 7 cases. There were no significant differences among the suction-stylet, suction-no stylet, and stylet-no suction groups in specimen adequacy rate (87.1, 88.2, 85.9%, respectively) or diagnostic yield of malignancy (32.2, 31.8, 31.0%, respectively). However, the use of suction was associated with an increase in tissue-core acquisition rate (P < 0.001). The no-stylet procedure decreased the average procedural time by 14 s (P < 0.001). There was no significant difference in the amount of bleeding among the procedures. Conclusions: The use of suction or non-use of an inner-stylet does not make a significant difference in cytological specimen adequacy or diagnostic yield when performing EBUS-TBNA. While omitting the stylet can simplify the procedure, applying suction can increase the tissue-core acquisition rate. These findings may assist endoscopic physicians in determining the optimal EBUS-TBNA procedure and warrant clinical verification in a future multicentre study. Trial registration: Trial registration: (ChiCTR-IOR-17010616). Retrospective registered date: 12th February, 2017.

AB - Background: The optimal procedure for maximizing the diagnostic yield and minimizing the procedural complexity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is controversial. We conducted a prospective randomized controlled trial to determine the optimal procedure of EBUS-TBNA for mediastinal and hilar lymphadenopathy, with a particular focus on the roles of the inner-stylet and suction. Methods: Consecutive patients with enlarged mediastinal and hilar lymph nodes (LNs), detected by computed tomography (CT) or positron emission tomography-CT (PET-CT), who underwent EBUS-TBNA were included. Each LN was sampled with three needle passes using suction-stylet, suction-no stylet, and stylet-no suction procedures. The samples were smeared onto glass slides for cytological evaluation. A single, blinded cytopathologist evaluated each set of slides. The primary outcomes were cytological specimen adequacy rate and diagnostic yield of malignant LNs. The secondary outcomes were tissue-core acquisition rate, procedural time, and the amount of bleeding. Results: This study evaluated 97 patients with a total of 255 LNs. The final LN diagnosis was benign in 144, malignant in 104, and inadequate in 7 cases. There were no significant differences among the suction-stylet, suction-no stylet, and stylet-no suction groups in specimen adequacy rate (87.1, 88.2, 85.9%, respectively) or diagnostic yield of malignancy (32.2, 31.8, 31.0%, respectively). However, the use of suction was associated with an increase in tissue-core acquisition rate (P < 0.001). The no-stylet procedure decreased the average procedural time by 14 s (P < 0.001). There was no significant difference in the amount of bleeding among the procedures. Conclusions: The use of suction or non-use of an inner-stylet does not make a significant difference in cytological specimen adequacy or diagnostic yield when performing EBUS-TBNA. While omitting the stylet can simplify the procedure, applying suction can increase the tissue-core acquisition rate. These findings may assist endoscopic physicians in determining the optimal EBUS-TBNA procedure and warrant clinical verification in a future multicentre study. Trial registration: Trial registration: (ChiCTR-IOR-17010616). Retrospective registered date: 12th February, 2017.

KW - Clinical trial

KW - Endobronchial ultrasound-guided transbronchial needle aspiration

KW - Lymphadenopathy

KW - Malignant

UR - http://www.scopus.com/inward/record.url?scp=85058020723&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058020723&partnerID=8YFLogxK

U2 - 10.1186/s12890-018-0751-0

DO - 10.1186/s12890-018-0751-0

M3 - Article

C2 - 30526587

AN - SCOPUS:85058020723

VL - 18

JO - BMC Pulmonary Medicine

JF - BMC Pulmonary Medicine

SN - 1471-2466

IS - 1

M1 - 192

ER -