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Letter to the Editor
Endobronchial Ultrasound Guided Needle Sampling Without Aspiration: And the Cell Block?
Punción guiada por ultrasonografía endobronquial sin aspiración: ¿y el bloque celular?
Felipe Andreo Garcíaa,c,
Corresponding author
fandreo@separ.es

Corresponding author.
, José Sanz Santosa, Maria Llatjós Sanuyb,c, Juan Ruiz Manzanoa
a Servicio de Neumología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
c Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Bunyola, Mallorca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the article by Rodriguez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in which the authors present a study on mediastinal sampling using endobronchial ultrasound guided fine-needle capillary sampling &#40;EBUS-FNC&#41; instead of transbronchial needle aspiration &#40;EBUS-TBNA&#41;&#44; in which a negative pressure is applied via syringe&#46; The authors report the interesting benefits of not applying suction to EBUS-guided puncture&#58; the technique is simpler&#44; procedure time is reduced&#44; and adequate and representative material comparable to that of EBUS-TBNA may be obtained with less contamination from bleeding&#46; However&#44; a very important issue not highlighted in the article is the efficiency of the technique in obtaining cell blocks &#40;CB&#41;&#46; Madan and Guleria<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> recently expressed concern regarding the possible differential yield when the histological core is obtained without the application of suction&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The preparation of CB from EBUS-TBNA samples is a simple way to provide additional information in the diagnosis of lung cancer&#46; In our experience<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in lung cancer&#44; CB obtained by EBUS-TBNA generally provided clinically relevant information in 83 of 270 patients &#40;30&#46;7&#37;&#41;&#46; Puncture was repeated up to three times and preservation of material for CB was possible in almost half of the aspirates&#46; Of a total of 697 transbronchial aspirates&#44; CB were available in 334 &#40;47&#46;9&#37;&#41;&#46; In 50 cases &#40;7&#46;2&#37;&#41;&#44; conventional extensions were not diagnostic while the CB were&#44; and the malignancy diagnosed from extensions could be subtyped in four patients&#46; Genetic analyses could also be performed from CB in 60&#37; of patients with adenocarcinoma&#46; CB samples were processed by air drying and coagulation on filter paper&#46; For this&#44; a blood sample is needed&#44; and that is more likely to be obtained when negative pressure is applied with a syringe&#46; Since the absence of suction produces less trauma&#44; this technique is less likely to ensure a clot formation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Several oncology societies<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> have published guidelines recommending the necessary identification of molecular abnormalities for the initiation of specific treatment&#46; Even today and certainly in the near future&#44; EBUS will face the challenge of demonstrating its usefulness in the comprehensive analysis of all the newly available molecular studies<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in advanced neoplastic diseases&#44; for which histopathological samples obtained by biopsy or surgical techniques have been routinely used&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It must be shown that useful CB can be obtained &#40;even if they are prepared in liquid medium&#41; by FNC instead of TBNA in an adequate proportion of cases&#44; without increasing the number of punctures&#46; A direct comparison is needed of the equivalence of the yield of the CB material obtained by each technique in terms of amounts &#40;differences in cellularity&#41; and quality for immunohistochemistry and molecular analyses&#44; and not only the purely diagnostic yield&#46; Until such evidence is available&#44; we believe that FNC can be considered a useful alternative in cases where contamination by bleeding for immediate examination may render the sample inadequate&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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ISSN: 15792129
Original language: English
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