title: Stylet Use Does Not Improve Diagnostic Outcomes in Endobronchial Ultrasonographic Transbronchial Needle Aspiration: A Randomized Clinical Trial.
abstract: Endobronchial ultrasonographically guided transbronchial needle aspiration (EBUS-TBNA) of thoracic structures is a commonly performed tissue sampling technique. The use of an inner-stylet in the EBUS needle has never been rigorously evaluated and may be unnecessary.
  
  
  
  In a prospective randomized single-blind controlled clinical trial, patients with a clinical indication for EBUS-TBNA underwent lymph node sampling using both with-stylet and without-stylet techniques. Sample adequacy, diagnostic yield, and various cytologic quality measures were compared.
  
  
  
  One hundred twenty-one patients were enrolled, with 194 lymph nodes sampled, each using both with-stylet and without-stylet techniques. There was no significant difference in sample adequacy or diagnostic yield between techniques. The without-stylet technique resulted in adequate samples in 87% of the 194 study lymph nodes, which was no different from the with-stylet adequacy rate (82%; P = .371). The with-stylet technique resulted in a diagnosis in 50 of 194 samples (25.7%), which was similar to the without-stylet group (49 of 194 [25.2%]; P = .740). There was a high degree of concordance in the determination of adequacy (84.0%; 95% CI, 78.1-88.9) and diagnostic sample generation (95.4%; 95% CI, 91.2-97.9) between the two techniques. A similar qualitative number of lymphocytes, malignant cells, and bronchial respiratory epithelia were recovered using each technique.
  
  
  
  Omitting stylet use during EBUS-TBNA does not affect diagnostic outcomes and reduces procedural complexity.
  
  
  
  ClinicalTrials.Gov: No. NCT 02201654; URL:www.clinicaltrials.gov.
authors: Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego School of Medicine, La Jolla, CA.
authors: Eric L
authors: EL
authors: Scholten
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Roy
authors: R
authors: Semaan
authors: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Peter
authors: P
authors: Illei
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Christopher
authors: C
authors: Mallow
authors: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami, Miller School of Medicine, Miami, FL.
authors: Sixto
authors: S
authors: Arias
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: David
authors: D
authors: Feller-Kopman
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Karen
authors: K
authors: Oakjones-Burgess
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Bernice
authors: B
authors: Frimpong
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Ricardo O
authors: RO
authors: Amador
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Hans
authors: H
authors: Lee
authors: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: lyarmus@jhmi.edu.
authors: Lonny
authors: L
authors: Yarmus
mesh_terms: D000368:Aged; D001980:Bronchi; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006099:Granuloma / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D016037:Single-Blind Method
keywords: EBUS-TBNA; interventional bronchoscopy; pathology; stylet