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    "titulo" => "Three-Year Experience With the 19-Gauge Endobronchial Ultrasound Needle&#58; A Sarcoidosis Perspective"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The utility of endobronchial ultrasound &#40;EBUS&#41; guided transbronchial needle aspiration &#40;TBNA&#41; for patients with suspected sarcoidosis is well established&#46; However&#44; the reported diagnostic yield has varied from 80 to 94&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3</span></a> Many new EBUS needles have been introduced in the last 5 years&#46; Tyan et al&#46; and this author had separately published small series with reported yield of 93&#37; using a 19-G needle for sarcoidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a> One of the drawbacks of these studies was small sample size&#46; Despite introduction of this particular device almost 4 years ago&#44; larger studies detailing performance of this needle for granulomatous inflammation or lympho-proliferative disorders have not been published&#46; We would like to share diagnostic and safety data from our experience over 3 years in a community hospital with selective use of this instrument&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Electronic medical record system was retrospectively reviewed to identify patients who underwent EBUS-TBNA between July 2016 and July 2019&#46; This study was approved by Institutional Review Board &#40;Maine General Medical Center&#44; Augusta&#44; ME&#44; USA&#41;&#46; Medical records were reviewed to identify needle gauge&#44; sampling location&#44; diagnosis and any immediate complication from the procedure&#46; Patients in which only 19 G needle &#40;ViziShot FLEX 19G needle&#44; Olympus America&#44; Redmond&#44; WA&#44; USA&#41; was used were selected&#46; Available follow up records were reviewed&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">EBUS procedure</span><p id="par0015" class="elsevierStylePara elsevierViewall">All EBUS included in data analysis were performed under general anesthesia &#40;Propofol infusion with or without remifentanil&#41; with endotracheal intubation by anesthesia providers&#46; White light bronchoscopy was performed prior to convex probe EBUS survey in all patients &#40;Olympus BF-1TH190&#44; BF-1THQ190&#59; Olympus BF-UC180F and ultrasound image processor EU-ME1&#59; Olympus America&#41;&#46; 19-gauge needle was preferentially used in patients with clinical suspicion of sarcoidosis&#44; lymphoma or for cancer restaging&#46; The designated lymph node &#40;LN&#41; was punctured under direct EBUS guidance&#46; Suction was used with all passes unless significant vascularity and&#47;or bleeding was noted with the preceding passes&#46; At least 4 passes were done at each station&#46; An additional pass was done if no visible aspirate was obtained on any of the attempted aspirate&#46; Part of the aspirated material from first<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>second pass was smeared on to glass slides&#46; Remainder of the aspirate was discharged into 95&#37; ethanol for cell block preparation by using stylet or blowing air&#46; Smears were air-dried and fixed in 95&#37; ethanol&#46; Rapid on-site evaluation &#40;ROSE&#41; was used in all cases in order to ensure sampling adequacy&#46; Adequate cell material was defined as presence of lymphoid tissue of adequate cellularity or sufficient for a specific diagnosis&#44; such as the presence of noncaseating granulomas without necrosis&#46; TBNA was terminated if latter was reported and subsequent biopsies performed at discretion of bronchoscopist&#46; Bronchioalveolar lavage&#44; transbronchial lung biopsy &#40;TBLB&#41; and endobronchial biopsy were performed in a standard fashion and samples fixed in formalin for histopathological examination&#46; Post-procedure chest X-ray was performed in all patients undergoing TBLB&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Information about needle size was available for 436 patients out of 577 patients who underwent EBUS during the study period&#46; Only 19 G needle was used in 72 patients&#46; Final pathological diagnosis based on biopsy included granulomatous inflammation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&#44; benign lymph node &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#44; metastatic malignancy &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#44; lympho-proliferative disorder &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; and non-diagnostic &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; The approximate size of sampled lymph nodes varied from 8 to 40<span class="elsevierStyleHsp" style=""></span>mm&#46; Sarcoidosis was suspected in 40 patients in the 19 G needle group and confirmed with flexible bronchoscopy in 39&#46; Females constituted 60&#37; &#40;24&#41; of the patients&#46; Average age was 52 years &#40;range 26&#8211;79 years&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnostic yield of EBUS-TBNA and TBLB for sarcoidosis was 97&#46;5&#37; &#40;39&#47;40&#41;&#46; The diagnostic yield of TBNA alone for pathological confirmation of granulomatous inflammation was 92&#46;5&#37; &#40;37&#47;40&#41;&#46; TBLB was diagnostic in 2 cases without a TBNA diagnosis&#46; Eighty-four LNs were sampled in the sarcoidosis group&#46; Median number of LN sampled per patient was 2&#46; The diagnostic yield for sarcoidosis per sampled LN was 83&#46;3&#37; &#40;70&#47;84&#41;&#46; Station 7 LN was most frequently sampled &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; with a diagnostic yield of 88&#37;&#46; The diagnostic yield of various locations and biopsies for sarcoidosis is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All patients with unexplained benign lymphadenopathy were followed up for at least 6 months&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">No procedure related adverse events were noted&#46; One anesthesia related adverse event occurred&#46; We had two instances of sheath breakage from the needle as previously reported<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> without any damage to the bronchoscope&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The current review adds to the growing literature on the utility of EBUS TBNA for establishing the diagnosis of granulomatous inflammation in patients with mediastinal and hilar lymphadenopathy&#46; The randomized controlled studies published using this needle were directed toward malignant lymphadenopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Therefore&#44; we would like to share our 3-year experience and diagnostic data with selective use of this needle&#46; The needle is marketed as being more flexible as compared to other needles and authors experience is in-line with prior published reports&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> We continued to observe a high diagnostic yield for sarcoidosis&#46; However&#44; opposed to our initial findings where we did not see an incremental benefit from TBLB&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> in this continuation series 2 patients &#40;5&#37;&#41; were diagnosed solely on basis of TBLB&#46; Both these patients had firm LNs with scant aspirate&#46; One patient was clinically diagnosed with sarcoidosis based on response to steroid despite benign cytology and the procedure was considered non-diagnostic&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">No patient in this series required additional tissue sampling for diagnosis of granulomatous inflammation&#46; While this review was directed toward sarcoidosis patients&#44; it was noted by the author that many of these patients were referred for evaluation of lymphoma given the overlap in symptoms and radiographic findings&#46; We were able to establish a diagnosis of lympho-proliferative disorder in 7 patients but 57&#37; &#40;4&#47;7&#41; required repeat procedures for subtyping&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The sheath breakage events were reported to the manufacturer and no manufacturing defect was identified&#46; In both the instances&#44; lymph nodes were firm and lymph node puncture was deemed challenging&#46; We speculate that the incidents could be related to the excessive torsional strain on the needle&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since the introduction of this needle&#44; newer needles have been marketed with the promise of providing core specimens&#46; There is a shift toward endoscopic needle biopsy over aspiration in the gastroenterology literature&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Similar trend might be noted in pulmonary medicine in coming years as the need for tissue increases&#46; In the absence of comparative data&#44; good performance data and familiarity with design might be a factor for some proceduralists to continue using this needle&#46; It is possible that different attributes of each needle might make them better suited for different pathologies&#46; We share our data to add to the scant available literature about using this needle for granulomatous lymphadenopathy&#46;</p></span></span>"
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                  \t\t\t\t">70 &#40;83&#46;3&#37;&#41;&nbsp;\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">TBNA&#42; Station 2R&#44; 2L&nbsp;\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">0&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\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">TBNA Station 4R&nbsp;\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">15&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;66&#46;6&#37;&#41;&nbsp;\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">TBNA Station 4L&nbsp;\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">4&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;75&#37;&#41;&nbsp;\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
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                  \t\t\t\t">TBNA Station 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;88&#46;2&#37;&#41;&nbsp;\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">TBNA Station 10R&nbsp;\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">2&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;50&#37;&#41;&nbsp;\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">TBNA Station 10L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;100&#37;&#41;&nbsp;\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">TBNA Station 11R&nbsp;\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">9&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;88&#46;8&#37;&#41;&nbsp;\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">TBNA Station 11 L&nbsp;\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">19&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;83&#46;3&#37;&#41;&nbsp;\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">Transbronchial lung biopsy&nbsp;\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
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Endobronchial lung biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Scientific Letter
Three-Year Experience With the 19-Gauge Endobronchial Ultrasound Needle: A Sarcoidosis Perspective
Experiencia de tres años con la aguja de ecografía endobronquial de 19G: perspectiva desde la sarcoidosis
Akshu Balwan
Division of Pulmonary and Critical Care, ME, United States
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    "titulo" => "Three-Year Experience With the 19-Gauge Endobronchial Ultrasound Needle&#58; A Sarcoidosis Perspective"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The utility of endobronchial ultrasound &#40;EBUS&#41; guided transbronchial needle aspiration &#40;TBNA&#41; for patients with suspected sarcoidosis is well established&#46; However&#44; the reported diagnostic yield has varied from 80 to 94&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3</span></a> Many new EBUS needles have been introduced in the last 5 years&#46; Tyan et al&#46; and this author had separately published small series with reported yield of 93&#37; using a 19-G needle for sarcoidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a> One of the drawbacks of these studies was small sample size&#46; Despite introduction of this particular device almost 4 years ago&#44; larger studies detailing performance of this needle for granulomatous inflammation or lympho-proliferative disorders have not been published&#46; We would like to share diagnostic and safety data from our experience over 3 years in a community hospital with selective use of this instrument&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Electronic medical record system was retrospectively reviewed to identify patients who underwent EBUS-TBNA between July 2016 and July 2019&#46; This study was approved by Institutional Review Board &#40;Maine General Medical Center&#44; Augusta&#44; ME&#44; USA&#41;&#46; Medical records were reviewed to identify needle gauge&#44; sampling location&#44; diagnosis and any immediate complication from the procedure&#46; Patients in which only 19 G needle &#40;ViziShot FLEX 19G needle&#44; Olympus America&#44; Redmond&#44; WA&#44; USA&#41; was used were selected&#46; Available follow up records were reviewed&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">EBUS procedure</span><p id="par0015" class="elsevierStylePara elsevierViewall">All EBUS included in data analysis were performed under general anesthesia &#40;Propofol infusion with or without remifentanil&#41; with endotracheal intubation by anesthesia providers&#46; White light bronchoscopy was performed prior to convex probe EBUS survey in all patients &#40;Olympus BF-1TH190&#44; BF-1THQ190&#59; Olympus BF-UC180F and ultrasound image processor EU-ME1&#59; Olympus America&#41;&#46; 19-gauge needle was preferentially used in patients with clinical suspicion of sarcoidosis&#44; lymphoma or for cancer restaging&#46; The designated lymph node &#40;LN&#41; was punctured under direct EBUS guidance&#46; Suction was used with all passes unless significant vascularity and&#47;or bleeding was noted with the preceding passes&#46; At least 4 passes were done at each station&#46; An additional pass was done if no visible aspirate was obtained on any of the attempted aspirate&#46; Part of the aspirated material from first<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>second pass was smeared on to glass slides&#46; Remainder of the aspirate was discharged into 95&#37; ethanol for cell block preparation by using stylet or blowing air&#46; Smears were air-dried and fixed in 95&#37; ethanol&#46; Rapid on-site evaluation &#40;ROSE&#41; was used in all cases in order to ensure sampling adequacy&#46; Adequate cell material was defined as presence of lymphoid tissue of adequate cellularity or sufficient for a specific diagnosis&#44; such as the presence of noncaseating granulomas without necrosis&#46; TBNA was terminated if latter was reported and subsequent biopsies performed at discretion of bronchoscopist&#46; Bronchioalveolar lavage&#44; transbronchial lung biopsy &#40;TBLB&#41; and endobronchial biopsy were performed in a standard fashion and samples fixed in formalin for histopathological examination&#46; Post-procedure chest X-ray was performed in all patients undergoing TBLB&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Information about needle size was available for 436 patients out of 577 patients who underwent EBUS during the study period&#46; Only 19 G needle was used in 72 patients&#46; Final pathological diagnosis based on biopsy included granulomatous inflammation &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&#44; benign lymph node &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#44; metastatic malignancy &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#44; lympho-proliferative disorder &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; and non-diagnostic &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; The approximate size of sampled lymph nodes varied from 8 to 40<span class="elsevierStyleHsp" style=""></span>mm&#46; Sarcoidosis was suspected in 40 patients in the 19 G needle group and confirmed with flexible bronchoscopy in 39&#46; Females constituted 60&#37; &#40;24&#41; of the patients&#46; Average age was 52 years &#40;range 26&#8211;79 years&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnostic yield of EBUS-TBNA and TBLB for sarcoidosis was 97&#46;5&#37; &#40;39&#47;40&#41;&#46; The diagnostic yield of TBNA alone for pathological confirmation of granulomatous inflammation was 92&#46;5&#37; &#40;37&#47;40&#41;&#46; TBLB was diagnostic in 2 cases without a TBNA diagnosis&#46; Eighty-four LNs were sampled in the sarcoidosis group&#46; Median number of LN sampled per patient was 2&#46; The diagnostic yield for sarcoidosis per sampled LN was 83&#46;3&#37; &#40;70&#47;84&#41;&#46; Station 7 LN was most frequently sampled &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; with a diagnostic yield of 88&#37;&#46; The diagnostic yield of various locations and biopsies for sarcoidosis is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All patients with unexplained benign lymphadenopathy were followed up for at least 6 months&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">No procedure related adverse events were noted&#46; One anesthesia related adverse event occurred&#46; We had two instances of sheath breakage from the needle as previously reported<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> without any damage to the bronchoscope&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The current review adds to the growing literature on the utility of EBUS TBNA for establishing the diagnosis of granulomatous inflammation in patients with mediastinal and hilar lymphadenopathy&#46; The randomized controlled studies published using this needle were directed toward malignant lymphadenopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Therefore&#44; we would like to share our 3-year experience and diagnostic data with selective use of this needle&#46; The needle is marketed as being more flexible as compared to other needles and authors experience is in-line with prior published reports&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> We continued to observe a high diagnostic yield for sarcoidosis&#46; However&#44; opposed to our initial findings where we did not see an incremental benefit from TBLB&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> in this continuation series 2 patients &#40;5&#37;&#41; were diagnosed solely on basis of TBLB&#46; Both these patients had firm LNs with scant aspirate&#46; One patient was clinically diagnosed with sarcoidosis based on response to steroid despite benign cytology and the procedure was considered non-diagnostic&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">No patient in this series required additional tissue sampling for diagnosis of granulomatous inflammation&#46; While this review was directed toward sarcoidosis patients&#44; it was noted by the author that many of these patients were referred for evaluation of lymphoma given the overlap in symptoms and radiographic findings&#46; We were able to establish a diagnosis of lympho-proliferative disorder in 7 patients but 57&#37; &#40;4&#47;7&#41; required repeat procedures for subtyping&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The sheath breakage events were reported to the manufacturer and no manufacturing defect was identified&#46; In both the instances&#44; lymph nodes were firm and lymph node puncture was deemed challenging&#46; We speculate that the incidents could be related to the excessive torsional strain on the needle&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since the introduction of this needle&#44; newer needles have been marketed with the promise of providing core specimens&#46; There is a shift toward endoscopic needle biopsy over aspiration in the gastroenterology literature&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Similar trend might be noted in pulmonary medicine in coming years as the need for tissue increases&#46; In the absence of comparative data&#44; good performance data and familiarity with design might be a factor for some proceduralists to continue using this needle&#46; It is possible that different attributes of each needle might make them better suited for different pathologies&#46; We share our data to add to the scant available literature about using this needle for granulomatous lymphadenopathy&#46;</p></span></span>"
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                  \t\t\t\t">NA&nbsp;\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">TBNA Station 4R&nbsp;\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">15&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;66&#46;6&#37;&#41;&nbsp;\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">TBNA Station 4L&nbsp;\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">4&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;75&#37;&#41;&nbsp;\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">TBNA Station 7&nbsp;\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">34&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;88&#46;2&#37;&#41;&nbsp;\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">TBNA Station 10R&nbsp;\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">2&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;50&#37;&#41;&nbsp;\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">TBNA Station 10L&nbsp;\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">1&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#37;&#41;&nbsp;\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">TBNA Station 11R&nbsp;\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">9&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;88&#46;8&#37;&#41;&nbsp;\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">TBNA Station 11 L&nbsp;\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">19&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;83&#46;3&#37;&#41;&nbsp;\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">Transbronchial lung biopsy&nbsp;\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">33&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;26&#37;&#41;&nbsp;\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">Endobronchial lung biopsy&nbsp;\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">38&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 15792129
Original language: English
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