Leftover aspirated material in the EBUS-TBNA suction syringe improves diagnostic yield: A prospective study

BackgroundDuring endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), visible aspirated material may accumulate in the suction syringe but is typically discarded.ObjectiveTo assess whether cytological examination of suction-syringe aspirate improves the diagnostic performance of EBUS-TBNA.DesignProspective, single-center, paired-sample diagnostic study.MethodsPooled aspirated material was preserved in formalin and analyzed cytologically alongside routine EBUS-TBNA specimens. Diagnostic yield, adequacy, and accuracy were compared with/without syringe aspirate analysis.ResultsAmong 355 screened patients, 151 (42.5%) had visible syringe aspirate and were included. Adding syringe aspirate increased diagnostic yield from 58.3% to 62.9% (+4.6%, p=0.016). Sample adequacy remained unchanged (98.7%). Accuracy for excluding malignancy improved from 85.4% to 88.1%, although not significantly (p=0.125). Concordance between TBNA and syringe samples was 87.9%. Seven diagnoses, including four malignancies, were established exclusively from syringe aspirate.ConclusionCytological analysis of suction-syringe aspirate modestly but significantly enhances EBUS-TBNA diagnostic yield and should be considered in routine practice.