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Comparison of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration With Stylet Retracted Partially Versus Completely for Molecular Testing

Fernandez-Bussy, Sebastian MD*; Biswas, Abhishek MD; Labarca, Gonzalo MD; Jantz, Michael A. MD; Mehta, Hiren J. MD

Journal of Bronchology & Interventional Pulmonology: July 2019 - Volume 26 - Issue 3 - p 222–224
doi: 10.1097/LBR.0000000000000596
Brief Report

Background: Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is considered to be the initial diagnostic modality for most patients with lung cancer. However, the optimal technique for maximizing yield continues to vary in the real-world setting.

Objectives: To evaluate the diagnostic yield of EBUS-TBNA with capillary sampling compared with complete stylet removal for molecular testing.

Methods: Retrospective study, data from patients between January to May 2017 with indication of EBUS-TBNA whom ancillary testing, that is, next-generation sequencing, anaplastic lymphoma kinase (ALK), and programed death ligand-1 (PD-L1) expression was reviewed. The yield of 2 techniques, stylet retracted halfway (group 1) versus complete retraction (group 2), was compared.

Results: A total of 24/27 (88.88%) samples were adequate for next-generation sequencing analysis in group 1 and 21/23 (91.30%) in group 2. For other molecular analyses, 24/27 (88.88%) samples in group 1 and 20/23 (86.95%) samples in group 2 were adequate for ALK analysis. 23/27 (85.18%) samples for group 1 and 20/23 (86.95%) samples for group 2 were adequate for PD-L1 analysis. Positive expression of PD-L1>50% was achieved in 9/23 (39.13%) of group 1 and 5/20 (25%) of group 2. There was no statistical difference in the yield between the 2 groups.

Conclusion: EBUS-TBNA using either capillary sampling or complete stylet removal are effective and has a high proportion of satisfactory results for ancillary testing.

*Division of Pulmonary and Critical Care Medicine, Mayo Clinic

Division of Pulmonary/Critical care/Sleep Medicine, University of Florida College of Medicine, Gainesville, FL

School of Medicine, San Sebastian University, Concepcion, Chile

H.J.M., A.B., and M.A.J.: contributed to the study design, data collection, and manuscript writing. G.L.: contributed to the study design, data analysis, and manuscript writing. S.F.-B.: contributed to data collection and manuscript writing.

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Sebastian Fernandez-Bussy, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224 (e-mail:

Received July 20, 2018

Accepted April 11, 2019

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