Scientific Letter
Cytologic Contamination of the Sampling Needle in Endobronchial Ultrasound
La contaminación citológica de la aguja de punción en ecobroncoscopia
J.M. Tirapu Puyala,
, N. Múgica Atorrasagastib, M.V. Leal Arranza, J.C. Santana Astudillob, J.C. Lopez Duquec, L. Ortega Comunianc, M. Rezola Bajinetad, N. Segues Merinod
Corresponding author
a Servicio de Neumología, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
b Servicio de Neumología, Hospital Universitario Donostia, Donostia/San Sebastián, Guipúzcoa, Spain
c Servicio de Anatomía Patológica, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
d Servicio de Anatomía Patológica, Hospital Universitario Donostia, Donostia/San Sebastián, Guipúzcoa, Spain
Read
2472
Timeswas read the article
874
Total PDF
1598
Total HTML
Share statistics
array:24 [ "pii" => "S0300289622001715" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.07.018" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "3035" "copyright" => "SEPAR" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2022;58:T367-T368" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289621003343" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.09.014" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "2926" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2022;58:369-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Is There an Association Between Nocturia and Nighttime Hypertension in Patients With Moderate to Severe Sleep Apnea?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "369" "paginaFinal" => "371" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Existe una asociación entre nicturia e hipertensión nocturna en pacientes con apnea del sueño moderada-grave?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patricia Lloberes, Maria Guadalupe Silveira, Julia Sampol, Cristina Esquinas, Eugenia Espinel, Roser Ferrer, Marta Gonzalo, Gabriel Sampol" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Patricia" "apellidos" => "Lloberes" ] 1 => array:2 [ "nombre" => "Maria Guadalupe" "apellidos" => "Silveira" ] 2 => array:2 [ "nombre" => "Julia" "apellidos" => "Sampol" ] 3 => array:2 [ "nombre" => "Cristina" "apellidos" => "Esquinas" ] 4 => array:2 [ "nombre" => "Eugenia" "apellidos" => "Espinel" ] 5 => array:2 [ "nombre" => "Roser" "apellidos" => "Ferrer" ] 6 => array:2 [ "nombre" => "Marta" "apellidos" => "Gonzalo" ] 7 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Sampol" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621003343?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000004/v5_202301090807/S0300289621003343/v5_202301090807/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289621002258" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.07.011" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "2899" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2022;58:367-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "La contaminación citológica de la aguja de punción en ecobroncoscopia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "367" "paginaFinal" => "368" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cytologic Contamination of the Sampling Needle in Endobronchial Ultrasound" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Tirapu Puyal, N. Múgica Atorrasagasti, M.V. Leal Arranz, J.C. Santana Astudillo, J.C. Lopez Duque, L. Ortega Comunian, M. Rezola Bajineta, N. Segues Merino" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Tirapu Puyal" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Múgica Atorrasagasti" ] 2 => array:2 [ "nombre" => "M.V." "apellidos" => "Leal Arranz" ] 3 => array:2 [ "nombre" => "J.C." "apellidos" => "Santana Astudillo" ] 4 => array:2 [ "nombre" => "J.C." "apellidos" => "Lopez Duque" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Ortega Comunian" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Rezola Bajineta" ] 7 => array:2 [ "nombre" => "N." "apellidos" => "Segues Merino" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621002258?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000004/v5_202301090807/S0300289621002258/v5_202301090807/es/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0300289621002258" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.07.011" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "2899" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2022;58:367-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "La contaminación citológica de la aguja de punción en ecobroncoscopia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "367" "paginaFinal" => "368" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cytologic Contamination of the Sampling Needle in Endobronchial Ultrasound" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Tirapu Puyal, N. Múgica Atorrasagasti, M.V. Leal Arranz, J.C. Santana Astudillo, J.C. Lopez Duque, L. Ortega Comunian, M. Rezola Bajineta, N. Segues Merino" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Tirapu Puyal" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Múgica Atorrasagasti" ] 2 => array:2 [ "nombre" => "M.V." "apellidos" => "Leal Arranz" ] 3 => array:2 [ "nombre" => "J.C." "apellidos" => "Santana Astudillo" ] 4 => array:2 [ "nombre" => "J.C." "apellidos" => "Lopez Duque" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Ortega Comunian" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Rezola Bajineta" ] 7 => array:2 [ "nombre" => "N." "apellidos" => "Segues Merino" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621002258?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000004/v5_202301090807/S0300289621002258/v5_202301090807/es/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => " Cytologic Contamination of the Sampling Needle in Endobronchial Ultrasound" "tieneTextoCompleto" => true "saludo" => "To the Director," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T367" "paginaFinal" => "T368" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Tirapu Puyal, N. Múgica Atorrasagasti, M.V. Leal Arranz, J.C. Santana Astudillo, J.C. Lopez Duque, L. Ortega Comunian, M. Rezola Bajineta, N. Segues Merino" "autores" => array:8 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Tirapu Puyal" "email" => array:2 [ 0 => "JOSEMIGUELANTONIO.TIRAPUPUYAL@osakidetza.eus" 1 => "tirapuyal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "N." "apellidos" => "Múgica Atorrasagasti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.V." "apellidos" => "Leal Arranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.C." "apellidos" => "Santana Astudillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "J.C." "apellidos" => "Lopez Duque" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "Ortega Comunian" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "M." "apellidos" => "Rezola Bajineta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "N." "apellidos" => "Segues Merino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Donostia, Donostia/San Sebastián, Guipúzcoa, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Donostia, Donostia/San Sebastián, Guipúzcoa, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La contaminación citológica de la aguja de punción en ecobroncoscopia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Linear endobronchial ultrasound is a procedure that has revolutionized the diagnosis and staging of lung cancer. The evidence in favor of this minimally invasive technique have led it to replace mediastinoscopy in many indications.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This approach has been recommended by many scientific societies,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3–5</span></a> but one of its limitations is the potential for needle contamination by tumor cells. For this reason, consensus was reached<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6–8</span></a> to start staging at station N3 and then progress to N1.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The IASLC Staging and Prognostic Factors Committee found prognostic differences between patients with single or multiple N1 or N2 station involvement, but decided not to include it in their 8th edition.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> If the need for multiple station sampling is demonstrated in the future, it will be important to determine the risk of needle contamination and to establish the need to change the needle after the first positive node station.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study was designed to test whether the risk of contamination of the needle by tumor cells is a real issue.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The secondary objective was to develop strategies that would make this contamination undetectable, in order to avoid false positives in subsequent node stations. Potential contamination was assessed by ThinPrep (a method of filtering and enriching cytological samples in liquid medium).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study and study documentation were approved by the Basque Clinical Research Ethics Committee.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The design was prospective, multicenter, and non-randomized, and the study objectives did not require a control group. We included patients of both sexes attending the 2 participating hospitals due to suspected primary lung tumor disease requiring linear endobronchial ultrasound for diagnosis or staging, with no contraindications to the procedure, and who gave their consent to participate in this study. Only true ROSE (Rapid On Site Examination) positives were included in the study. The statistical analysis was performed using IBM SPSS v23. The threshold for statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05. Sixty-two patients met the inclusion criteria.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Mean age was 65.45 years (SD 9.31 years); 47 patients were men (75.8%).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Stations 4 R and 7 were the most frequently aspirated. The mean smallest diameter of the nodes was 18.31<span class="elsevierStyleHsp" style=""></span>mm (6–46<span class="elsevierStyleHsp" style=""></span>mm; SD 10.7<span class="elsevierStyleHsp" style=""></span>mm).</p><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows persistent oncocytological material detectable in the fluid after the needle was flushed 2 and 3 times, as assessed by Thinprep, thus demonstrating the cytological contamination of the needle. Additional volumes of saline serum did not eliminate this contamination.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Recognizable residual cell positivity was found in 43.5% of the combination of both flushes.</p><p id="par0060" class="elsevierStylePara elsevierViewall">There were no significant differences in age, sex, node size, or anatomopathological results. Nor were there any significant differences in variables such as TNM or its isolated descriptors.</p><p id="par0065" class="elsevierStylePara elsevierViewall">After the data obtained from the 2 flushes after normal processing were analyzed, the volume was increased to a single 5<span class="elsevierStyleHsp" style=""></span>ml flush and then to 10<span class="elsevierStyleHsp" style=""></span>ml.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In both cases, the fluid obtained with 1<span class="elsevierStyleHsp" style=""></span>ml of saline after these flushes contained recognizable tumor cells after ThinPrep processing.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A search of the literature in Cochrane on Ovid using the terms “endobronchial ultrasound”, “needle” and “contamination” returned 460 references.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Some of them refer to the potential contamination of samples by material that complicates interpretation, such as bronchial cells or blood<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10,11</span></a> or by the needle releasing metal particles into tissues,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> whereas only 2 refer to contamination of aspiration needles by tumor cells in endobronchial ultrasound-guided samples.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Kwong et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> report contamination of the working channel, the endoscope tip, and the needle catheter in endoscopic ultrasound-guided fine needle aspiration in gastrointestinal tumors. This publication drew attention to the possibility that contamination of the aspiration needle may contribute to false-positive findings.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The only reference that mentions tumor cell contamination of the needle in endobronchial ultrasound is a poster published in the 2017 ATS Congress.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> This study shows that such contamination exists. The authors designed a single strategy to eliminate the problem – flushing the needle with 10<span class="elsevierStyleHsp" style=""></span>ml saline – but contamination persisted, so they advocate sequential staging. The authors do not state if they used ROSE during the diagnostic procedure.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Our study is unique in that it includes only cases diagnosed by ROSE, and besides false positives were ruled out (negatives in the definitive examination).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Our primary objective was fulfilled, revealing a 43.5% rate of persistent recognizable tumor cells in the combination of flushing procedures.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The secondary objective was not achieved, since the various needle flushing strategies, the last of which was the same as reported by Berim et al.,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> failed to eliminate oncocytic contamination.</p><p id="par0110" class="elsevierStylePara elsevierViewall">There was no statistically significant relationship between the variables studied, so we could not determine any factors that would be useful in assessing the likelihood of needle contamination by tumor cells. One of the limitations of this study is the small population studied, which may explain this result.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Our study shows that tumor cell contamination of the endobronchial ultrasound-guided aspiration needle is a real issue and one that can lead to false positives at other stations (particularly if ROSE is not practiced), but we could not define a strategy to eliminate the problem.</p><p id="par0120" class="elsevierStylePara elsevierViewall">If multiple station staging is included in a future edition of the TNM, our results suggest that using a new needle after a first positive node station is advisable.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors state no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:2 [ "identificador" => "xack645375" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valid percentage \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cumulative percentage \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Valid negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Residual cell positivity after flushing. Combined flushes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ten years of linear endobronchial ultrasound: evidence of efficacy. Safety and cost-effectiveness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Fernández-Villar" 1 => "C. Mouronte-Roibás" 2 => "M. Botana-Rial" 3 => "A. Ruano-Ravina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2015.08.007" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "96" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26565072" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0080" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Ernst" 1 => "D. Anantham" 2 => "R. Eberhardt" 3 => "M. Krasnik" 4 => "F.J.F. Herth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/JTO.0b013e31817535e" "Revista" => array:6 [ "tituloSerie" => "J Thorac Oncol" "fecha" => "2008" "volumen" => "3" "paginaInicial" => "577" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18520794" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0085" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.C. Detterbeck" 1 => "S.Z. Lewis" 2 => "R. Diekemper" 3 => "D. Addrizzo-Harris" 4 => "W.M. Alberts" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.12-2377" "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "2013" "volumen" => "143" "numero" => "Suppl." "paginaInicial" => "7S" "paginaFinal" => "37S" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23649434" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0090" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. De Leyn" 1 => "C. Dooms" 2 => "J. Kuzdzal" 3 => "D. Lardinois" 4 => "B. Passlick" 5 => "R. Rami-Porta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ejcts/ezu028" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2014" "volumen" => "45" "paginaInicial" => "787" "paginaFinal" => "798" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24578407" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0095" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SEPAR guidelines for lung cancer staging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Sánchez de Cos" 1 => "J.H. Hernández" 2 => "M.F. Jimenez" 3 => "S.P. Sánchez" 4 => "A.R. Gratacós" 5 => "R.R. Porta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2011.06.013" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "454" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21824707" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0100" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of appropriate mediastinal staging among endobronchial ultrasound bronchoscopists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. Miller" 1 => "L. Mudambi" 2 => "M.R. Vial" 3 => "M. Hernandez" 4 => "G.A. Eapen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/AnnalsATS.201606-487OC" "Revista" => array:6 [ "tituloSerie" => "Ann Am Thorac Soc" "fecha" => "2017" "volumen" => "14" "paginaInicial" => "1162" "paginaFinal" => "1168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28399376" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0105" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration for systematic nodal staging of lung cancer in patients with N0 disease by computed tomography and integrated positron emission tomography-computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ong" 1 => "H. Grosu" 2 => "G.A. Eapen" 3 => "M. Rodriguez" 4 => "D. Lazarus" 5 => "D. Ost" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/AnnalsATS. 201409-429OC" "Revista" => array:6 [ "tituloSerie" => "Ann Am Thorac Soc" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "415" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25584815" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0110" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How should performance in EBUS mediastinal staging in lung cancer be measured?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Evison" 1 => "P. Crosbie" 2 => "N. Navani" 3 => "M. Callister" 4 => "R.C. Rintoul" 5 => "D. Baldwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/bjc.2016.253" "Revista" => array:6 [ "tituloSerie" => "Br J Cancer" "fecha" => "2016" "volumen" => "115" "paginaInicial" => "e9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27552438" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1552526013029397" "estado" => "S300" "issn" => "15525260" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0115" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The eighth edition lung cancer stage classification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F.C. Detterbeck" 1 => "D.J. Boffa" 2 => "A.W. Kim" 3 => "L.T. Tanoue" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2016.10.010" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2017" "volumen" => "151" "paginaInicial" => "193" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27780786" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0120" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration: a pilot study to evaluate the utility of the procore biopsy needle for lymph node sampling" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Xing" 1 => "S. Manos" 2 => "S.E. Monaco" 3 => "D.O. Wilson" 4 => "L. Pantanowitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000446761" "Revista" => array:6 [ "tituloSerie" => "Acta Cytol" "fecha" => "2016" "volumen" => "60" "paginaInicial" => "254" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27400235" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0125" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy of EBUS-guided transbronchial needle aspiration for molecular testing in lung adenocarcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Jurado" 1 => "A. Saqi" 2 => "R. Maxfield" 3 => "A. Newmark" 4 => "M. Lavelle" 5 => "M. Bacchetta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2013.05.066" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2013" "volumen" => "96" "paginaInicial" => "1196" "paginaFinal" => "1202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23972930" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0130" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Release of metal particles from needles used for transbronchial needle aspiration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Gounant" 1 => "V. Ninane" 2 => "X. Janson" 3 => "M. Colombat" 4 => "M. Wislez" 5 => "D. Grunenwald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.10-0371" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2011" "volumen" => "139" "paginaInicial" => "138" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20538818" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0135" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant cell contamination may lead to false-positive findings at endosonographic fine needle aspiration for tumor staging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.T. Kwong" 1 => "W.J. Coyle" 2 => "F. Hasteh" 3 => "M.R. Peterson" 4 => "T.J. Savides" 5 => "M.L. Krinsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0033-1358922" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2014" "volumen" => "46" "paginaInicial" => "149" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24415526" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0140" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contamination of needles used for endobronchial ultrasound guided biopsies: myth confirmed" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.G. Berim" 1 => "A. Colanta" 2 => "A. Saeed" 3 => "N. Nagan" 4 => "C. Landeen" 5 => "A. King" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2017" "volumen" => "195" "paginaInicial" => "A2868" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack645375" "titulo" => "Acknowledgements" "texto" => "<p id="par0130" class="elsevierStylePara elsevierViewall">Our thanks to Dr. Jonatan Vargas who as a student asked me to direct his final degree project and inspired me to conduct this study, to the respiratory endoscopy nursing staff in both participating hospitals (Isabel Poveda, Izaskun Azkueta, Dolores Morions), and to the participating cell technicians.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000004/v5_202301090807/S0300289622001715/v5_202301090807/en/main.assets" "Apartado" => array:4 [ "identificador" => "93642" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific Letters/Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000004/v5_202301090807/S0300289622001715/v5_202301090807/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622001715?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 1 | 11 |
| 2024 October | 90 | 22 | 112 |
| 2024 September | 81 | 21 | 102 |
| 2024 August | 76 | 32 | 108 |
| 2024 July | 37 | 19 | 56 |
| 2024 June | 56 | 23 | 79 |
| 2024 May | 68 | 28 | 96 |
| 2024 April | 32 | 21 | 53 |
| 2024 March | 40 | 24 | 64 |
| 2024 February | 32 | 27 | 59 |
| 2024 January | 28 | 28 | 56 |
| 2023 December | 61 | 22 | 83 |
| 2023 November | 45 | 29 | 74 |
| 2023 October | 80 | 25 | 105 |
| 2023 September | 43 | 27 | 70 |
| 2023 August | 38 | 28 | 66 |
| 2023 July | 51 | 23 | 74 |
| 2023 June | 51 | 18 | 69 |
| 2023 May | 34 | 18 | 52 |
| 2023 April | 38 | 40 | 78 |
| 2023 March | 55 | 35 | 90 |
| 2023 February | 29 | 25 | 54 |
| 2023 January | 26 | 42 | 68 |
| 2022 December | 49 | 19 | 68 |
| 2022 November | 57 | 29 | 86 |
| 2022 October | 80 | 36 | 116 |
| 2022 September | 49 | 21 | 70 |
| 2022 August | 42 | 42 | 84 |
| 2022 July | 39 | 51 | 90 |
| 2022 June | 53 | 41 | 94 |
| 2022 May | 125 | 57 | 182 |
| 2022 April | 2 | 0 | 2 |
| 2022 March | 1 | 0 | 1 |
Show all
