CHEST Guidelines-Acquisition-and-Handling-of-Endobronchial-Ultrasou

Acquisition-and-Handling-of-Endobronchial-Ultrasou

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The American College of Chest Physicians issued a detailed guideline regarding the acquisition and handling of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimens, particularly for lung cancer diagnosis and staging. While previous guidelines focused on when and how to perform EBUS-TBNA, this guideline specifically addresses specimen handling and processing to optimize diagnostic yield and preserve tissue integrity for subsequent studies. <br /><br />The guidelines result from a thorough review of literature and expert consensus, leading to nine key statements. Recommendations include using either standard clinical practices or alternative methods for specimen expulsion and alternative collection media like formalin, RPMI, saline, alongside traditional alcohol-based preparations, highlighting very low certainty in evidence for these methods.<br /><br />The guideline recommends rapid on-site evaluation (ROSE) over usual care in suspected malignant cases to improve diagnostic yields and suggests using smaller needles (21G or 22G) rather than larger needles (19G) due to concerns over tissue integrity and the potential for more blood contamination. Four or more needle passes are recommended to ensure sufficient tissue collection for molecular testing, reflecting strong support despite low certainty evidence.<br /><br />For suspected nonmalignant disease, either standard or alternative media are suggested, and ROSE is recommended to ensure precise specimen handling. Regarding needle size for nonmalignant cases, the guideline does not indicate a specific preference, suggesting either a larger or smaller needle.<br /><br />Overall, the document emphasizes the importance of local expertise and pathology collaboration in selecting expulsion methods and collection media. The need for additional research remains critical for advancing the understanding and methods of specimen handling and optimizing patient care in lung disease diagnosis.

Keywords

EBUS-TBNA

lung cancer diagnosis

specimen handling

diagnostic yield

rapid on-site evaluation

needle size

molecular testing

pathology collaboration

specimen expulsion

collection media