Comparing diagnostic sensitivity of different needle sizes for lymph nodes suspected of lung cancer in endobronchial ultrasound transbronchial needle aspiration: Systematic review and meta‐analysis

Abstract

Background: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure for evaluating hilar and mediastinal lymph nodes. The reported sensitivity and specificity of EBUS-TBNA are 95% and 97%, respectively. A comparison of diagnostic sensitivity for lymph nodes suspected of lung cancer according to needle size in EBUS-TBNA is needed.Objectives: To compare the diagnostic sensitivity of the 19-G, 21-G, 22-G and 25-G needles for lymph nodes suspected of non-small cell lung cancer (NSCLC) using EBUS-TBNA.Methods: A literature search from PubMed, EMBASE, LILACS, DOAJ and CENTRAL through October 2020 was performed by two reviewers. The extracted data were evaluated using STATA ® and Open Meta Analyst software for meta-analysis with a binary method model to compare sensitivity, specificity and summary receiver operating characteristic curve for each needle size.Results: Fourteen studies including 1296 participants were considered for the analysis. The overall sensitivity of EBUS-TBNA was 88.2% (95% CI 84%, 91%) and 93% (95% CI 88%, 95%) for the 19-G needle, 87.6% (95% CI 79.6%, 92.8%) for the 21-G needle and 85% (95% CI 80%, 88%) for the 22-G needle. The overall sensitivity of EBUS-TBNA for diagnosing NSCLC was 88.3% (95% CI, 81%, 93%) and 92.9% (95% CI, 85%, 97%) for the 19-G needle, 89.4% (95% CI 79.4%, 94.8%) for the 21-G needle and 82.1% (95% CI 66%, 91%) for the 22-G needle. Conclusion:The 19-G, 21-G and 22-G needles present a similarly high diagnostic sensitivity in EBUS-TBNA. The 19-G needle provided better sample adequacy for molecular and immunohistochemical testing, improving diagnostic yield in this subgroup.

Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement

“…EBUS‐TBNA is most commonly performed with gauge 22 needles, however, both 21‐ and 19‐gauge needles are available. Studies examining the effect of needle gauge have not shown any difference in diagnostic yield when a 22 gauge needle is compared to the larger gauge 54 and 19 gauge, 55,56 including for lymphoma 31,57,58 . Therefore, no specific recommendation for needle gauge can be made, but increasing the size of needle used might be considered as part of an action plan if key performance indicators have not been met during the quality assurance review.…”

“…Studies examining the effect of needle gauge have not shown any difference in diagnostic yield when a 22 gauge needle is compared to the larger gauge 54 and 19 gauge, 55,56 including for lymphoma. 31,57,58 Therefore, no specific recommendation for needle gauge can be made, but increasing the size of needle used might be considered as part of an action plan if key performance indicators have not been met during the quality assurance review. Newer endoscopic needle types are being developed, including those designed to replicate histological biopsy rather than traditional FNA.…”

“…132 Limited evidence to date suggests that a 19G TBNA needle may provide more adequate material for molecular analysis. 58,133 It is also important to record the number of repeat procedures required to provide additional tissue which is a marker of quality, as well as of poor patient experience (quality indicator also <10%). The need for a repeat procedure (including mediastinoscopy) may arise due to either inadequate specimen or inadequate tissue to complete required molecular testing (Figure 1).…”

Optimising tissue acquisition and the molecular testing pathway for patients with non-small cell lung cancer: A UK expert consensus statement

“…Emerging evidence supports the use of larger-gauge needles when performing EBUS-TBNA in patients with lung cancer. A pooled analysis showed a higher sensitivity for a 19G needle [65]. The larger 19G is also more flexible and allows improved access to more challenging areas such as station 4L and the hilar lymph node stations.…”

The role of endosonography-guided fine needle aspiration in preoperative restaging in the era of novel neoadjuvant therapies—a literature review

“…As the sensitivity of endosonography-guided needle aspiration varies widely (44-72%) for restaging in the studies reporting an average of three needle passes (67,68). More frequently obtained bloody cytologic specimens and inadequate specimens due to more difficulty in puncturing the tissue with a 19-gauge needle might have caused its lower than expected performance (68).…”