Conventional transbronchial needle aspiration with 23 gauge needle: a preliminary study

Conventional transbronchial needle aspiration (cTBNA) is a safe and minimally invasive procedure with a high yield for the diagnosis of large lymph nodes (LNs) in favourable locations (LNs >1.5 cm in stations #4R and/or #7). However, it is usually underutilized by pulmonologist. One of the main reasons given for not performing cTBNA is the risk of puncturing vascular structures of the mediastinum. Recently, with the twofold objective of minimize the risk of bleeding and reduce the cTBNA cost, a thinner and less expensive needle has been commercialized. It is a 23 gauge (G) needle that costs 34, 37 €. The aim of our study was to analyze the sample adequacy, diagnostic accuracy and safety of this needle in comparison with 21 and 22 G needles (average cost: 6,400 €).

We retrospectively analysed medical records from patients who underwent bronchoscopy with cTBNA for the diagnosis of LNs >1.5 cm in stations #4R and/or #7 at the Thoracic Endoscopy Unit of the University Hospital of Parma from January 1st, 2007 to October 31(st), 2011. Five hundred patients underwent cTBNA from January 1(st), 2007 to October 31(st), 2011. In order to reduce the technical and personal bias for sampling procedure we analyzed only cases sampled by a single well-trained bronchoscopist, particularly skilful at cTBNA.

A total of 222 patients (186 men; mean age 63 years±12, range 6-89) with LNs >1.5 cm in stations #4R and/or #7 were identified. A 23 G needle was used in 84 patients (38%), a 21 G needle in 88 patients (40%) and a 22 G needle in 50 patients (22%). No statistically significant differences between the 23 G group and the 21 or 22 G group in sample adequacy (P=0.78 and P=0.12, respectively) and diagnostic accuracy (P=0.9 and P=0.4, respectively) were found. There were no intraprocedural or postprocedural complications irrespective of the size of needle used.

Transbronchial 23 G needle is as safe and effective as the 21 and 22 G needle for the sampling of LNs >1.5 cm in stations #4R and/or #7. For this reason, to obtain cytology specimens from large LNs in favourable locations, the 23 G needle may represent an alternative and less expensive choice compared to 21 and 22 G needles, even if our observation needs to be confirmed in a larger prospective study.