Comparing the Clinical Performance of the New 19-G ViziShot FLEX and 21- or 22-G ViziShot 2 Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Needles

Abstract

Objective Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure for pulmonary and mediastinal diseases. This study compared the performance of a novel 19-G needle with a 21- or 22-G needle. Patients and Methods Eleven patients at Okayama Medical Center were enrolled retrospectively between April and December 2017. Enlarged lymph nodes and a pulmonary nodule were sampled with both 19-G and 21- or 22-G needles in nine patients. Two patients underwent biopsies for suspected lymphoma with only the 19-G needle. We examined their medical records on the diagnosis, size of the lymph nodes and pulmonary nodule, and complications. Results The median longest diameter of the 13 lymph nodes (8 #7, 4 #4R, and 1 #11) and 1 pulmonary nodule (right segment 6) in the 11 patients was 31.6 mm (range, 10-45 mm). Definitive diagnoses were made using the 19-G needle in nine patients. EBUS-TBNA with a 19-G needle resulted in successful diagnoses of one case of retinal hemangioblastoma, one case of tuberculous lymphadenitis, and one case of lung adenocarcinoma, as well as the evaluation of the programmed death-ligand 1 (PD-L1) expression following initial negative findings after a 21- or 22-G biopsy. A small pulmonary nodule (lung squamous cell carcinoma) with negative findings after a 19-G biopsy was diagnosed with a 22-G biopsy. Two suspected lymphoma patients were diagnosed with a 19-G needle: one had lymphoma and the other sarcoidosis. Three patients were diagnosed with sarcoidosis using both the 19-G and 21- or 22-G needles. Conclusion EBUS-TBNA with a 19-G needle was useful for diagnosing retinal hemangioblastoma and tuberculous lymphadenitis as well as for PD-L1 testing after 21- and 22-G biopsies were unsuccessful.

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

“…Both concluded that although sensitivity for each needle alone was similarly high, the additional pass with the 19-G resulted in a statistically significant increase in the overall diagnostic yield, from 92% to 99% (p = 0.045), suggesting an improved performance of the 19-G needle compared with the 21-G or 22-G needles. 12,16,17 However, we found no significant difference in diagnostic yield between the 19-G, 21-G and 22-G needles in this metaanalysis.…”

“…12,19,21,22 However, we observed no difference in sensitivity resulting from the application of ROSE, and in fact, studies that did not use ROSE presented a higher diagnostic sensitivity. Minami et al 17 reported the lowest sensitivity out of all studies while implementing this histopathologic evaluation, possibly due to the low number of participants. One study from Japan analysed their samples with and without ROSE but did not provide detailed information for each subgroup.…”

Improved Diagnostic Yield and Specimen Quality With Endobronchial Ultrasound-Guided Forceps Biopsies: A Retrospective Analysis

“…7 Whether the newer, larger 19-gauge needles confer an advantage over smaller needles is the subject of ongoing investigation. [15][16][17] The use of EBUS for extracting lymph node biopsy specimens with forceps rather than with needle aspiration has been described, and results suggest that the combination of both techniques improves yield over SOC alone. [18][19][20] In a significant number of patients, however, the forceps encounter resistance and consequently does not pass reliably through the bronchial wall and into the targeted lymph node.…”

Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications

“…PD-L1 positivity appears to be higher in certain patients with NSCLC: males, smokers, advanced pathologic stages, positive vessel invasion, and positive lymphatic invasion (27). Tissue specimens derived from EBUS-TBNA has been found to be reliable to perform molecular bio-marker analysis (28). However, this is dependent on the cutoff value used for a sample to be considered PD-L1 positive (29).…”