A new needle on the block: EchoTip ProCore endobronchial ultrasound needle

Abstract

Endobronchial ultrasound has become the first choice standard of care procedure to diagnose benign or malignant lesions involving mediastinum and lung parenchyma adjacent to the airways owing to its characteristics of being real-time and minimally invasive. Although the incidence of lung cancer has been decreasing, it is and will be the leading cause of cancer-related mortality in the next few decades. When compared to other cancers, lung cancer kills more females than breast and colon cancers combined and more males than colon and prostate cancers combined. The type of lung cancer has changed in recent decades and adenocarcinoma has become the most frequent cell type. Prognosis of lung cancer depends upon the cell type and the staging at the time of diagnosis. The cell type and molecular characteristics of adenocarcinoma may allow individualized targeted treatment. Other malignant conditions in the mediastinum and lung (eg, metastatic lung cancers and lymphoma) can be biopsied using endobronchial ultrasound needles. Endobronchial ultrasound needle biopsies provides mostly cytology specimens due to its small sizes of needles (22 gauge or larger) which may not give enough tissue to make a definitive diagnosis in malignant (eg, lymphoma) or benign conditions (eg, sarcoidosis). EchoTip ProCore endobronchial needle released in early 2014 provides histologic biopsy material. Larger tissue biopsies may potentially provide a higher diagnostic yield and it eliminates mediastinoscopy or other surgical interventions. Here we aim to review bronchoscopic approach in the diagnosis of mediastinal lesions with emphasis of EchoTip ProCore needles.

Endobronchial ultrasound guided Echo Tip Ultra HD 22G needle versus Echo Tip Pro Core HD 22G needle in diagnosis of mediastinal lesions

“…In conclusion, the Echo Tip ProCore needle was designed to collect the cytology and core biopsy specimens at the needle tip and the reverse-beveled side of the needle, respectively. Accordingly, core tissue samples will allow practitioners to fewer passes and less need to consider surgical sampling [16]. However, in this study, the Echo Tip ProCore needle-diagnosed cases were dependent upon cytological sampling and not on the core biopsy specimen which was small and moreover crushed and inadequate for diagnosis.…”

Accidental breakage of needle tip during endobronchial ultrasound-guided transbronchial needle aspiration

“…Advantages of these needles are resistance to permanent bends and kinks at curved or angulated positions, maintenance of integrity even after multiple passes and also adoption of twist-lock technology for precise sheath and needle length adjustments. [ 21 ] Although theoretically this needle may sound to be better, the experience with it is limited. There are not enough comparative data to suggest that this needle is better than others.…”

Biopsy needles for mediastinal lymph node sampling by endosonography: current knowledge and future perspectives

“…Also, 22G and 25G needles have been proposed in order to collect histological biopsy: these needles are 33% more flexible than the conventional 22G and have an adjustable needle extension up to 5 cm (22). So far, it has not been proven that one needle is better than the other, even though several minor advantages have been reported in some studies with the use of 21G needle (5).…”