Diagnostic utility of miniprobe guided transbronchial needle aspiration using a novel transbronchial aspiration needle

Background: Radial probe Endobronchial Ultrasound (R-EBUS) guided transbronchial lung biopsy (TBLB) is a well established diagnostic technique for evaluation of peripheral lung lesions. Diagnostic yield, however, of this procedure has been reported to be 58.3 to 80% in various studies. We evaluated a novel Periview Flex needle™ (Olympus) in order to improve diagnostic yield of this technique. Methods: Radial-EBUS guided Transbronchial needle aspiration (TBNA) with the novel Periview Flex needle was performed between March 2018 and January 2019 for obtaining tissue diagnosis of lung lesions. We compared the diagnostic yield to our historical data of Radial EBUS guided TBLB performed between June 2017 and October 2018. Results: 7 procedures of Radial-EBUS guided TBNA were performed with a overall diagnostic yield of 85.71%; sensitivity of 83.33% (95% CI- 35.88% to 99.58%) and specificity of 100% (95% CI – 2.50% to 100%) for malignancy. One patient was diagnosed with non-tuberculous mycobacterial infection despite being investigated for lung cancer. One patient had post procedural pneumothorax which resolved spontaneously with conservative management. Previously our diagnostic yield was 40% for Radial EBUS guided TBLB with sensitivity of 40%(95% CI- 12.16% to 73.76%) for malignancy. However the difference of diagnostic yields between these two methods was not statistically significant(p-value = 0.134). Conclusion: Radial-EBUS guided TBNA using Periview Flex needle is a promising technique, with a potential to increase the diagnostic yield for lung lesions as compared to Radial EBUS guided TBLB. This technique will need further evaluation to confirm our findings.