Abstract
Advancements in personalized medicine have increased the demand for quantity and preservation of tissue architecture of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples. These demands may be addressed by the SonoTip TopGain® needle, which has a 3-point crown-cut design that contrasts with the standard single bevel design of the ViziShot 2®. The objective was to compare the SonoTip TopGain® and ViziShot 2® needles by considering biopsy sample characteristics, diagnostic accuracy, and patient safety. The primary endpoint of the study was the number of high-power fields (HPFs) in the center of the formalin-fixed paraffin-embedded cell block per sample. The lymph node with the highest probability for malignant infiltration based on size and sonographic appearance was chosen as the target lymph node for 20 patients. The same lymph node in each patient was sampled using both the ViziShot 2® and SonoTip TopGain® needles. The samples were measured, sliced, and analyzed by a pathologist. Sixteen patients were biopsied with both needles. Four patients could not be biopsied with the SonoTip TopGain® needle since it could not penetrate cartilage or be repositioned to bypass cartilage. HPFs and sample dimensions were significantly greater in the patients where sampling with the SonoTip TopGain® needle was possible (p = 0.007 and p = 0.005, respectively). Diagnostic accuracy and safety profiles were comparable. Significantly more material can be sampled using the SonoTip TopGain® needle when cartilage penetration can be avoided. This improves the yield for molecular workup in the era of personalized medicine.
Highlights
The diagnostic accuracy of Endobronchial ultrasound (EBUS) for mediastinal staging has been shown to be comparable to mediastinoscopy but with the benefit of a superior safety profile [3,4,5,6,7,8,9]
Lymph node samples could be collected from all 20 patients using the ViziShot 2®
If the four additional patients that were biopsied using only the ViziShot 2® are included in the comparison, the ViziShot 2® yielded a mean sample dimension of 0.21 cm (SD = 0.089 cm), p = 0.001
Summary
Endobronchial ultrasound (EBUS) has evolved to be the first-line tool for the workup and staging of pulmonary primary tumors, metastases, and enlarged mediastinal and hilar lymph nodes in patients with sarcoidosis, tuberculosis, cancers, and lymphomas [1,2,3]. The diagnostic accuracy of EBUS for mediastinal staging has been shown to be comparable to mediastinoscopy but with the benefit of a superior safety profile [3,4,5,6,7,8,9]. Recent advancements in personalized oncology and immunotherapies requiring specialized staining, especially for programmed-death ligand 1 and mutational analysis via generation sequencing (NGS), have increased the demand for improved quantity and preservation of tissue architecture of biopsies sampled using EBUS-TBNA.
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