Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration With 19-Gauge vs 21- or 22-Gauge Needle for Mediastinal Lymphadenopathy

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been established as safe and effective in evaluating the mediastinum for malignant lymphadenopathy, with sensitivity reported at 92% to 95% with 21- and 22-gauge endobronchial ultrasound (EBUS) needles. Results for lymphoma and benign conditions such as sarcoidosis are significantly lower. Research Question Does a 19-gauge EBUS needle increase diagnostic performance over smaller needles (21 or 22 gauge) in patients with a preprocedural diagnosis of suspected sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed? Study Design and Methods This study retrospectively examined patient records from the Stather Canadian Outcomes Registry for Chest Procedures database, and included patients who underwent EBUS-TBNA for a preprocedural diagnosis of suspected sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed. Patients were separated into those who received EBUS-TBNA with a 19-gauge vs 21-/22-gauge needle. We performed a propensity score matching analysis with a 1:2 ratio and an inverse probability of treatment weighting approach, with diagnostic yield (DY) as the primary end point. Results The data set was extracted from the Stather Canadian Outcomes Registry for Chest Procedures database on July 1, 2023, and included 1,810 procedures (19-gauge group: n=195; 21-/22-gauge group: n=1,615). The DY of EBUS-TBNA procedures with propensity score matching analysis was 230 of 316 (72.8%) in the 21-/22-gauge group vs 116 of 158 (73.4%) in the 19-gauge group (difference, 0.6%; 95% CI, −8.1 to 8.7%; P = .88). With the inverse probability of treatment weighting analysis, the DY was 1,117.8 of 1,606.7 (69.6%) in the 21-/22-gauge group vs 90.5 of 122.3 (74.0%) in the 19-gauge group (difference, 4.4%; 95% CI, −4.3 to 11.7%; P = .30). Interpretation We did not identify a statistically significant difference in DY between the 19-gauge EBUS needles over the 21-/22-gauge needles in this patient population.