Real-Life Comparison of Diagnostic Yield and Sample Adequacy of 22 G and 25 G EBUS-TBNB Needles: A Retrospective Study.

Background/

Objectives

EBUS-TBNA is a safe and minimally invasive procedure to evaluate hilar and mediastinal lymph nodes (LNs). The Franseen needle provides a transbronchial needle biopsy (TBNB). Various needle sizes are available. In the literature, diagnostic yield (DY) and sample adequacy (SA) between needle sizes are still being debated.

Methods

In total, 88 patients with lymphadenopathy were consecutively enrolled from June to December 2021. Chest CT and PET/CT scans were performed. Dimension at imaging and EBUS and the standardized uptake value (SUV) were recorded. EBUS-TBNB was performed with 22 G or 25 G needle sizes. DY for cancer and SA for predictive markers were evaluated. Overall DY (ODY) was also evaluated.

Results

A 22 G needle was used in 51 patients and a 25 G needle was used in 37 patients with no differences in sex and age. The 22 G population presented a larger median dimension of LN both at imaging and EBUS compared to the 25 G population. Median LN SUV was higher in the 22 G population. Notably, 70 out of 88 patients had LNs suspicious for malignancy, which was higher in the 22 G group compared to the 25 G group (n = 46, 90% vs. n = 24, 65%; p = 0.004). DY for cancer was similar in both groups (84% for 22 G; 91% for 25 G). Also, SA for predictive markers was similar. ODY values were 78% and 92%, respectively, for the 22 G and 25 G needles.

Conclusions

The 25 G needle has a higher DY (even if not statistically significant) and SA for predictive markers similar to the 22 G needle; further studies are necessary to evaluate if 25 G is comparable to the 22 G needle.