Comparison of a 22G crown-cut needle with a conventional 22G needle with EBUS guidance in diagnosis of sarcoidosis

Abstract

Background: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a standard procedure in cases of enlarged mediastinal lymph nodes. Recently, new tools were developed aiming to improve the diagnostic yield. A novel crown-cut needle is considered to obtain a tissue core which can be beneficial for the evaluation of the pathologist.

Objectives: The aim of this study was to compare the novel 22G crown-cut needle with a conventional 22G needle with EBUS guidance in the diagnosis of sarcoidosis.

Methods: We designed a single-center prospective randomized clinical trial between March 2020 and January 2021 with 30 patients with mediastinal lymphadenopathy and suspected sarcoidosis.

Results: 24 patients (mean age 49.5 vs 54.1, mean FVC 73.7% vs 86.7%, mean DLCO 72.4% vs 72.5% for crown-cut needle vs conventional needle, respectively) were diagnosed with sarcoidosis. For the remaining six patients sarcoidosis was excluded. One had a final diagnosis of anthracosilicosis. Diagnostic accuracy was 77% (10/13) with the crown-cut needle vs 82% (9/11) with the conventional needle (p=1.00). Four of seven examiners experienced difficulties passing through the bronchial wall with the crown-cut needle and one unusual bleeding occurred in this group which made the following interventions necessary: suction, application of sympathomimetic and compression with a swab.

Conclusions: The study showed that the needles were similiar in terms of diagnostic accuracy. However, there were hints that the crown-cut needle can lead to examination difficulties probably due to the lack of sharpness.