Guideline on handling endobronchial ultrasound transbronchial needle samples released

The American College of Chest Physicians (CHEST) recently released a new clinical guideline on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen processing and handling. Published in the journal CHEST, the guideline contains nine evidence-based recommendations to identify best practices for collection, processing, and handling of EBUS-TBNA specimens.

“Endobronchial ultrasound-guided transbronchial needle aspiration has become the standard for initial lung cancer diagnosis and staging, but there is little guidance available on handling and processing specimens during and after acquisition to help optimize both diagnostic yield and specimen preservation for downstream ancillary testing,” says Christopher Gilbert, DO, MS, FCCP, lead author on the guideline. “In [the panel’s] experience, sample collection varies widely between institutions. This guideline seeks to leverage learned experiences of both pulmonologists and pathologists to standardize the process.”

Evidence of the handling and processing of EBUS-TBNA specimens varies in strength but is satisfactory in some areas to guide clinicians in certain aspects of specimen handling. The guideline authors conclude that additional research in many aspects of specimen handling and processing is needed to help improve the knowledge base.

The recommendations of the guideline include:

• In patients with suspected malignant disease undergoing EBUS-TBNA, we recommend performing four or more needle passes over three or less needle passes. (Strong Recommendation)
• In patients with suspected malignant disease undergoing EBUS-TBNA, we suggest utilizing rapid on-site evaluation over usual care. (Conditional Recommendation)
• In patients with suspected malignant disease undergoing EBUS-TBNA, we suggest using a smaller needle (21 gauge or 22 gauge) over a larger needle (19 gauge). (Conditional Recommendation).