Real-life comparison of diagnostic yield (DY) and sample adequacy (SA) of 22G and 25G EBUS-TBNA needles: less is more?

Abstract

<b>Background:</b> Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure to evaluate hilar and mediastinal lymph nodes (LN). Various sized EBUS-TBNA needles are available. In literature, DY and SA between needle size are still debated. <b>Aim:</b> To compare DY and SA between 22G and 25G EBUS-TBNA needles used for hilar and mediastinal LN. <b>Methods:</b> 88 patients with lymphadenopathy were consecutively enrolled from June to December 2021. Positron emission tomography computed tomography (PET/CT) and/or chest CT scan were performed. Dimension at imaging and EBUS, and standardized uptake value (SUV) were recorded. EBUS-TBNA was performed with 22G or 25G needle size. DY and SA for predictive markers were evaluated. <b>Results:</b> 22G needle was used in 51 patients and 25G in 37, with no differences in sex and age (male 57% vs 68%,p=0.07;66 vs 72 years,p=0.19). 22G population presented a larger median dimension of LN both at imaging (20 vs 15 mm,p=0.001) and EBUS (20 vs 15 mm,p=0.005) compared to 25G population. Median LN SUV was higher in 22G population (12.8 vs 8.1,p=0.007). 70 of 88 patients had a suspect of LN malignancy, which was higher in 22G group compared to 25G group (n=46, 90% vs n=24, 65%;p=0.004). When cancer was suspected,DY was similar in both groups (82% vs 81%). Also, SA for predictive markers was similar in both groups (70% vs 67%). <b>Conclusions:</b> 25G needle has a similar DY and SA for predictive markers as 22G needle. In our experience, we used 22G needle for bigger LN with higher dimensions, higher SUV and suspected for cancer. Further studies are necessary to confirm that 25G needles DY and SA are comparable to 22G needle.