Comparison of the efficiency of endobronchial ultrasound-guided transbronchial needle aspiration using a 22G needle versus 25G needle for the diagnosis of lymph node metastasis in patients with lung cancer: a prospective randomized, crossover study.

BACKGROUND

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is generally performed for the diagnosis of hilar/mediastinal lymph node metastasis in patients with lung cancer. Recently, a 25-gauge (G) needle became available, but robust evidence of its usefulness in routine clinical practice is still lacking.

METHODS

A prospective randomized crossover trial was performed, in which patients with suspected hilar/mediastinal lymph node metastasis of lung cancer underwent EBUS-TBNA. The primary endpoint was the rate of yield histology specimens containing malignant cells.

RESULTS

From December 2018 to February 2020, 102 patients were randomly assigned to EBUS-TBNA using a 22G needle first, followed by a 25G needle (n=50) or EBUS-TBNA using a 25G needle first, followed by a 22G needle (n=52). There was no difference in the diagnostic yield of malignancy between the histology specimens obtained by using the 22G and 25G needles (75%

CONCLUSIONS

No significant difference in the diagnostic yield between the 22G and 25G needles was observed for the diagnosis of lymph node metastasis of lung cancer, suggesting that needles of either gauge could be used for the biopsy. However, we would recommend use of the 22G needle, because it provided larger specimens and specimens containing larger numbers of malignant cells.

TRIAL REGISTRATION

University hospital Medical Information Network Clinical Trial Registry (ID: UMIN000036680).

Informations de copyright

2021 Translational Lung Cancer Research. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tlcr-21-480). Dr. Sakai reports personal fees from AstraZeneca., outside the submitted work; Dr. Udagawa reports grants from Abbvie, MSD, AMGEN, Daiichi Sankyo and personal fees from Abbvie, MSD, Boehringer Ingelheim, Chugai, Taiho, Ono, Bristol-Myers Squibb, Amco, Daiichi Sankyo, AstraZeneca, outside the submitted work; Dr. Kirita reports personal fees from Olympus, Boston Scientific, MSD, Pfizer, Boeriger Ingelheim, Novartis, Chugai, Ono, Amco, Thermo Fisher Scientific, AstraZeneca, Lilly, outside the submitted work; Dr. Ota reports personal fees from AstraZeneca, Chugai, Boehringer Ingelheim, Cook Medical, MSD, Ono, Taiho, outside the submitted work; Dr. Zenke reports grants from AstraZeneca, MSD, Merck Serono and personal fees from AstraZeneca, MSD, Merck Serono, Lilly, Chugai, Ono, Taiho, Boheringer Ingelheim, Bristol-Myers Squibb, outside the submitted work; Dr. Matsumoto reports grants from Lilly, MSD, Novartis, Daiichi Sankyo, Chugai, Merck and personal fees from Novartis, Chugai, AstraZeneca, Guardant Health, Thermo Fisher Scientific, outside the submitted work; Dr. Yoh reports grants from AstraZeneca, Lilly, Pfizer, Taiho, Bayer, Takeda, Daiichi Sankyo, MSD, Abbvie and personal fees from AstraZeneca, Bristol-Myers Squibb, Chugai, Lilly, Taiho, Novartis, Daiichi Sankyo, Kyowa Kirin, Janssen, Boehringer Ingelheim, outside the submitted work; Dr. Niho reports grants from Lilly, AstraZeneca, MSD, Pfizer, Chugai, Merck Serono, Ono, Teijin, Sanofi, Shionogi, Boehringer Ingelheim, Taiho, Takeda and personal Lilly, AstraZeneca, MSD, Pfizer, Chugai, Ono, Boehringer Ingelheim, Taiho, Kyorin, Janssen, Novartis, outside the submitted work; Dr. Ishii reports grants from Ono, Daiichi Sankyo, Novartis, ORGANOGENIX and personal fees from Ono, Daiichi Sankyo, Novartis, Lilly, Taiho, Roche Diagnostics, Chugai, Oncolys BioPharma, outside the submitted work; Dr. Goto reports grants from MSD, Merck, Lilly, Amgen Astellas BioPharma, Chugai, Eisai, Ono, NEC, Janssen Pharmaceutical, Amgen, Daiichi Sankyo, Taiho, Kyowa Kirin, MEDICAL & BIOLOGICAL LABORATORIES, Boehringer Ingelheim, Takeda, Sumitomo Dainippon Pharm, Xcoo, Sysmex, Pfizer, KISSEI, Bristol-Myers Squibb, Merck Serono, AstraZeneca, Astellas, Loxo Oncology, Merus, Spectrum Pharmaceuticals, Ignyta, Shanghai Haihe Pharmaceutical, Thermo Fisher Scientific and personal fees from MSD, Lilly, Amgen Astellas BioPharma, Chugai, Eisai, Ono, Janssen Pharmaceutical, Amgen, Takeda, Thermo Fisher Scientific, Novartis, Nippon Kayaku, Otsuka, Guardant Health, outside the submitted work. The other authors have no conflicts of interest to declare.