Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle

Our plain-English summary of Endobronchial ultrasound-guided transbronchial needle aspiration with the flexible 19-gauge needle, by R. Trisolini, F. Natali, M. Ferrari, et al (The Clinical Respiratory Journal, 2018).

The study

• Authors: R. Trisolini, F. Natali, M. Ferrari, V. Livi, D. Paioli, M. Romagnoli, A. Cancellieri
• Journal: The Clinical Respiratory Journal
• Published: 2018;12(4):1725-1731
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction And Objectives: Endosonography has become standard of care in the diagnostic work-up of mediastinal lymphadenopathy and peribronchial lung lesions, but its success rate in some specific settings/conditions may be hampered by limited needle flexibility and size. We report on our initial experience with the 19G Flex needle, characterized by larger size and greater flexibility as compared with the currently available cytology needles.

Methods: Retrospective review of prospectively collected data on the first 13 consecutive patients submitted to endosonography with the 19G Flex needle. Patients were included if they had: (a) suspicion of a histologically complex disease (ie, lymphoma); (b) suspicion of an advanced lung cancer possibly requiring extensive genotyping; (c) a lesion whose sampling with a 22G needle had failed because of lack of visibility when the needle was loaded into the scope.

Results: The 13 patients enrolled had a mean age of 58.15 ± 17 years and a male to female ratio of 8:5. Target lesions (mean size 18.6 ± 6.4 mm) were lymphadenopathies (9 patients), lung lesions (3 patients) and a pleural nodule (1 patient). Histology core/s and a definite diagnosis (adenocarcinoma, 4 cases; lymphoma, 2; mesothelioma, 2, metastases from extrathoracic tumors, 2; non-small-cell lung cancer not otherwise specifiable, 1; small cell carcinoma, 1; sarcoidosis, 1) were obtained in 100% of patients. A single case of self-resolving bleeding was the only complication we observed.

Conclusions: Preliminary results obtained with the dedicated Flex 19G needle are promising, as sample size/quality is satisfactory and the needle influence on scope flexibility is minimal.

© 2017 John Wiley & Sons Ltd.

In plain English

This article from Bologna, Italy, described the authors' first experience with a new, more flexible 19-gauge biopsy needle. The needle is used in endosonography, where an ultrasound scope in the airway or esophagus samples chest lesions. The study did not look at asbestos exposure. The authors reviewed data on 13 patients (8 men) examined from June 2016 to March 2017. Patients were chosen because lymphoma, mesothelioma or advanced lung cancer possibly needing extensive genetic testing was suspected, because a smaller 22-gauge needle had failed, or, in one case, to re-biopsy known advanced adenocarcinoma for entry into an immunotherapy trial. A tissue core was obtained in all 13 patients and gave diagnostic material. Both patients suspected of mesothelioma were diagnosed with epithelioid mesothelioma. Lymphoma was confirmed in 2 of the 5 patients suspected of it. Cores were obtained in all 6 patients finally diagnosed with lung cancer, and genetic testing succeeded in all 3 where indicated. One patient had moderate bleeding that stopped on its own. The authors called the needle promising. They noted that the group was small and selected, and that the needle was not systematically compared with other needles.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of prospectively collected data (case series)
• Who was studied: 13 consecutive patients (8 male; mean age 58.15 plus or minus 17 years) examined with the 19G Flex needle at Maggiore Hospital, Bologna, Italy, from June 2016 to March 2017. They were selected for suspected lymphoma (5), suspected advanced lung cancer possibly requiring genotyping (3), suspected mesothelioma (2), failed sampling with a 22G needle (2), or re-biopsy of known advanced adenocarcinoma for entry into an immunotherapy clinical trial (1).
• Exposure: No asbestos or other environmental exposure was studied. What was evaluated was a medical device: the 19-gauge Flex needle (ViziShot Flex, Olympus), used for EBUS-TBNA or EUS-b-FNA biopsy. It is described as larger and more flexible than standard cytology needles.
• Main results:
  • In all 13 patients a histology core was obtained, and in every case it provided diagnostic material.
  • The lesions sampled were enlarged lymph nodes (9 patients in the abstract and table), lung lesions (3 patients) and a pleural nodule (1 patient). Their mean short-axis size was 18.6 plus or minus 6.4 mm.
  • Final diagnoses were adenocarcinoma in 4, lymphoma in 2, mesothelioma in 2, metastases from tumors outside the chest in 2, non-small-cell lung cancer not otherwise specifiable in 1, small cell carcinoma in 1, and sarcoidosis in 1.
  • In the 2 patients with suspected mesothelioma, large biopsies led to a confident diagnosis of epithelioid mesothelioma. One sample came from a lymph node in station #7 and the other from a pleural nodule behind the right main stem bronchus.
  • Of 5 patients with suspected lymphoma, lymphoma was confirmed in 2. In the other 3, the final diagnoses were sarcoidosis, pulmonary adenocarcinoma and small cell carcinoma.
  • Histology cores were obtained in 6 of 6 patients finally diagnosed with lung cancer. Accurate subtyping was possible in 5 of 6 (83%).
  • Cancer genotyping was successful in the 3 cases in which it was indicated.
  • Enough histology tissue was retrieved in the one patient biopsied for entry into an oncologic clinical trial on immune check-point inhibitors.
  • In the 2 patients whose lesions could not be sampled with a 22-gauge needle, switching to the Flex 19G needle during the same exam allowed successful sampling.
  • The only complication was one case of moderate bleeding that resolved on its own, in a patient with relapsed Hodgkin's lymphoma.
• The authors' conclusion: The authors concluded that the Flex 19-gauge needle has promising performance in both flexibility and specimen size. In their view, it may make diagnosis of histologically complex conditions and of angulated lesions more likely than with 22-gauge needles, and may make it easier to obtain enough tissue for genotyping. They said ongoing randomized trials will hopefully confirm these preliminary findings.
• Limitations the authors state:
  • The patients were a selected group, mostly with quite large lesions and/or specific clinical suspicions, so it is not yet proven that the results apply to a general population.
  • The Flex 19G needle was not systematically compared with 21G or 22G needles, except in the 2 cases where the 22G needle had failed.
  • The sample size was small.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Ultrasound, Lymphadenopathy, Flexibility, Cytology, Lung Cancer, Histology, Adenocarcinoma, Mesothelioma.

Related studies

• "Dry" pleural mesothelioma successfully diagnosed on endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) — F. Lococo, G. Rossi, et al. (2014)
• Endobronchial ultrasound-guided transbronchial needle aspiration in a patient with pericardial mesothelioma — H. Ashinuma, M. Shingyoji, et al. (2015)
• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma — J. Hamamoto, D. Notsute, et al. (2010)
• Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions — I. Skovgaard Christiansen, J.C. Kuijvenhoven, et al. (2019)
• Pseudomesotheliomatous carcinoma of lung adenocarcinoma diagnosed using transesophageal ultrasound-guided bronchoscopic aspiration — T. Sumi, H. Nakata, et al. (2021)

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