Evolution of transbronchial needle aspiration needles: Over the last half century

Transbronchial needle aspiration (TBNA) is a commonly used sampling approach in the diagnosis of hilar and mediastinal lymphadenopathy as well as peripheral lesions. As a very important tool, the continued innovation of TBNA needles is a vital driving force for the development of the technique. Although TBNA plays an important role in interventional pulmonology, there are no clear standards guiding operators to choose an appropriate needle for their operation. In recent decades, with the advent of endobronchial ultrasound-guided TBNA (EBUS-TBNA), the real-time visualization of TBNA has been enabled. These modern TBNA needles, such as ViziShot2, FLEX 19G, Acquire FNB, and EchoTip ProCore, have made significant progress in specimen collection, convenience, and safety, though still remain grounded in the basic premise and initial upgrades to the original conventional TBNA (cTBNA) needles. This review introduced the developmental history of WANG cTBNA needles, and summarized the lessons of success and failure and the enlightenments for currently used EBUS- and other emerging TBNA needles, aiming to provide a significant reference for pulmonologists who lived through the cTBNA era and for junior physicians who start working in the EBUS-TBNA era. Despite its long history, TBNA is still playing significant roles in the diagnosis of pulmonary diseases. A deeper understanding from the historical perspectives would facilitate continued innovations in the field of TBNA and beyond.