SESSION TITLE: Interventional Pulmonology SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: EBUS-TBNA sampling techniques vary greatly among physicians. One of those variations is the fanning technique which consists of sampling multiple areas within a lymph node in each pass by altering the angle of needle agitation. The flexibility of the new 19G EBUS-TBNA needle may allow the physicians to perform this technique more effectively. In 2013, a randomized trial comparing fanning and no-fanning techniques for EUS-FNA of pancreatic lesions showed that the fanning technique was superior. Though a difference in diagnostic accuracy between the fanning and no-fanning techniques (96.4% vs. 76.9%; P=0.05) couldn’t be established, fewer passes were required to establish a diagnosis using the fanning technique (Bang,J.Y.,et al. Endoscopy 2013). The goal of this evaluation was to compare the sample size of EBUS-TBNA samples obtained from simulated lymph node targets in ex-vivo calf lung using fanning and no-fanning techniques. METHODS: In fresh ex-vivo calf lungs, chunks of bovine heart and liver were placed next to the central airways via blunt dissection to create simulated lymph node targets. These tissue substrates with varying densities were selected to simulate the difference in densities between normal and diseased lymph nodes. The lungs were ventilated using negative pressure. Three operators experienced in EBUS-TBNA performed the evaluations with Olympus EBUS bronchoscopes and ViziShot FLEX 19G needles. In each target, fanning and no-fanning methods were performed with the same needle. For the no-fanning method, the needle was moved back and forth 12 times along the same pathline. For the fanning method, the needle was also moved back and forth 12 times but, after 3 to 4 agitations, the angle of the needle path through the target was changed primarily by flexing the scope. The depth of penetration and vacuum usage were controlled. Each sample was ejected onto a slide and photographed. The images were analyzed using ImageJ software to calculate the tissue core area. RESULTS: A total of 18 targets were placed in three calf lungs (one for each evaluator) at locations corresponding to lymph node stations 2L,4R,4L,7,10R,10L and 11R. Three operators collected a total of 24 paired samples from these targets. An equal number of samples were obtained from the heart and liver targets. Statistical analysis revealed that the fanning method collected significantly larger area tissue cores than no-fanning method (15.54 ± 9.79 vs.8.28 ± 6.16 mm2; P<0.001). Statistical significance was also observed comparing the two methods irrespective of the tissue substrate (heart 14.55 ± 9.65 vs.9.26 ± 6.87 mm2; P<0.05, liver 16.54 ± 10.25 vs.7.30 ± 5.49 mm2; P<0.01). CONCLUSIONS: In these controlled ex-vivo experiments, the fanning method collected significantly larger samples than the no-fanning method. This evaluation had certain limitations including lack of vasculature in the targets and no histopathology. Pre-clinical and clinical evaluations are warranted to confirm these results. CLINICAL IMPLICATIONS: The fanning technique may provide more material, which could be of clinical benefit for histological assessment and molecular analysis. The sampling of multiple locations within a lymph node may also improve diagnostic yield. DISCLOSURE: Sujeeth Parthiban: Employee: Employee of Olympus Respiratory America Anna Sczaniecka: Employee: Employee of Olympus Respiratory America David Dillard: Employee: Employee of Olympus Respiratory America Xavier Gonzalez: Employee: Employee of Olympus Respiratory America No Product/Research Disclosure Information