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IntroductionEBUS-TBNA is the current gold standard technique for lymph node sampling in mediastinal lymphadenopathy. Traditionally our trust has used size 21 gauge needles for all EBUS-TBNA cases, however recently we have used 19 gauge needles in an effort to increase diagnostic yield. We present preliminary Results from a small, randomised, single centre study assessing the sensitivity and safety of 19 gauge EBUS needles versus 21 gauge EBUS needles in EBUS-TBNA.MethodsPatients attending for EBUS-TBNA were prospectively randomised to either 19 gauge or 21 gauge groups. Samples were sent for analysis and the pathologist was blinded to the needle size used. The primary outcomes measured were positive sampling of lymphoid tissue and diagnostic sampling. Complications including severe bleeding and pneumothorax were included in the analysis.ResultsA total of 61 patients were enrolled in the study, with 32 assigned to the 21 gauge group and 29 assigned to the 19 gauge group. The average age was 57.5+/-6.8 years and 53.2+/-5.4 for the 21 gauge and 19 gauge groups respectively (p≥0.05). In the 21 gauge needle group lymphoid tissue was obtained in 27 of the 32 cases (84.38%), whereas the 19 gauge needle group lymphoid tissue was obtained in 25 of 29 cases (86.2%) (p≥0.05). Diagnostic sampling was obtained in 20 of the 32 (62.5%) cases in the 21 gauge needle group versus 19 of the 29 cases in the 19 gauge group (65.5%) (p≥0.05). None of our patients in either cohort suffered severe bleeding or pneumothorax.Conclusions/LimitationsCurrently our study has shown no significant difference in either sensitivity or safety between 19 and 21 gauge EBUS-TBNA. However we recognise that as yet our study is under powered and continued enrolment of patients is required to obtain valid Conclusions Given that size 21 gauge needles confer a significant cost saving (£7800 per annum) our trust are likely to continue using these needles if our preliminary Results are confirmed.

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Background: Renal oncocytoma accounts for 3 to 7% of all solid renal masses. Large renal oncocytomas (4 kg or more) are rare and only few cases are reported till date. Case Report: A 44 year old man presented with sudden onset right flank pain and large right abdominal lump. Further evaluation revealed a large heterogeneous mass not seen separately from right kidney. Intra-operatively a huge right renal mass (approximately 20 cm and 4.5 kg in weight) along with areas of necrosis and hemorrhage, completely replacing renal parenchyma was seen. Histopathology and immunohistochemistry was suggestive of oncocytoma. Conclusion: The renal oncocytoma can be differentiated from malignant RCCs by histopathology and immunohistochemically.