CHEST Guidelines-Acquisition and Handling of Endobronchial Ultrasound Transbronchial Needle Samples

Acquisition and Handling of Endobronchial Ultrasound Transbronchial Needle Samples

Pdf Summary

The American College of Chest Physicians has issued a clinical practice guideline focused on the acquisition and handling of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) samples, reflecting its crucial role in lung cancer diagnosis and staging. The guideline addresses gaps in existing protocols by providing recommendations on the handling and processing of EBUS-TBNA specimens to optimize diagnostic yield and tissue integrity.<br /><br />The guideline was developed through rigorous methods, including the systematic search and review of current literature using the Population, Intervention, Comparator, and Outcome (PICO) framework. From this review, nine evidence-based recommendations were formulated covering topics such as specimen sample expulsion methods, collection media, use of rapid on-site evaluation (ROSE), needle size, and the number of needle passes necessary for adequate sample collection.<br /><br />Key recommendations include using either standard clinical practice or alternative methods for specimen expulsion, employing either standard alcohol-based preparations or alternative media for samples, and preferring smaller gauge needles for suspected malignant diseases. For nonmalignant cases, the guideline suggests similar flexibility in media usage and endorses four or more needle passes to improve diagnostic outcomes.<br /><br />Despite recommendations based on available evidence, the guideline acknowledges the varied strength of the evidence backing these suggestions and underscores the need for further research. It emphasizes the importance of tailoring specimen handling and processing techniques to align with local clinical practices and cytopathology requirements, highlighting the value of inter-specialty collaboration in optimizing patient outcomes.

Keywords

EBUS-TBNA

lung cancer diagnosis

clinical practice guideline

specimen handling

diagnostic yield

PICO framework

rapid on-site evaluation

needle size

tissue integrity

inter-specialty collaboration