Endobronchial Ultrasound Transbronchial Needle Aspiration With a 19-Gauge Needle vs 21- and 22-Gauge Needles for Mediastinal Lymphadenopathy.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to evaluate mediastinal lymphadenopathy. Studies focusing on malignant lymphadenopathy have compared 21- and 22-gauge (21G and 22G, respectively) needles and have not identified an advantage of one needle size over the other in terms of diagnostic yield. RESEARCH QUESTION: Does the 19-gauge (19G) EBUS needle offer greater diagnostic yield and sensitivity vs the 21G and 22G EBUS needles for a diagnosis of sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed? STUDY DESIGN AND METHODS: This study retrospectively examined records of 730 patients from the Stather Canadian Outcomes Registry for Chest Procedures (SCOPE) database who underwent EBUS-TBNA for a diagnosis of suspected sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed. A propensity score analysis of two groups was performed. One group comprised patients undergoing EBUS-TBNA with a 19G needle, the other with a 21G or 22G needle. Cases for analysis were selected with a 1:2 ratio of 19G vs 21/22G using logistic regression and random matching with all eligible 19G cases included. RESULTS: There were 137 patients (312 targets) in the 19G group and 274 patients (631 targets) in the 21/22G group in the propensity score analysis. The diagnostic yield was 107 of 137 (78.1%) in the 19G group vs 194 of 274 (70.8%) in the 21/22G group (difference, 7.3%; 95% CI, -1.9 to 15.6; P = .116). The sensitivity of EBUS-TBNA for sarcoidosis was 80 of 83 (96.4%) in the 19G group vs 150 of 156 (96.2%) in the 21/22G group (difference, 0.24%; 95% CI, -6.6 to 85.1; P = .93). In patients with a final diagnosis of lymphoma, EBUS was diagnostic in 10 of 13 (76.9%) in the 19G group vs 12 of 12 (100%) in the 21/22G group (difference, 23.1%; 95% CI, -5.4 to 50.3; P = .08). INTERPRETATION: The study did not identify an advantage of the 19G EBUS needle over the 21/22G EBUS needles for diagnostic yield nor sensitivity for sarcoidosis or lymphoma.

A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation.

PURPOSE: A common peroneal nerve (CPN) palsy has been reported to complicate knee dislocations in 5-40 % of patients. Patients who suffer from a persistent foot drop have significantly worse functional outcomes. Reports on prognostic factors for nerve recovery or treatment-specific functional outcomes remain sparse in the literature. METHODS: Two independent reviewers completed a search of Medline, Embase, PubMed and the Cochrane Library from 1946 to present. Motor strength was determined using the Medical Research Council (MRC) grading system or an equivalent description. A functional recovery was defined as an MRC ≥3/5. RESULTS: The combined search of Medline, Embase, PubMed and the Cochrane Library identified 1528 abstracts. Thirteen articles met our inclusion/exclusion criteria. This included 214 CPN palsies. Functional recovery (MRC ≥3/5) following complete CPN palsy was 38.4 %. Full recovery (MRC = 5/5) following partial CPN palsy was 87.3 %. Younger age was predictive of neurologic recovery. Recovery following isolated neurologic interventions ranged from 0 to 30 %. CONCLUSIONS: A vastly different prognosis can be expected for patients who suffer an incomplete versus a complete CPN palsy. The majority of patients with an incomplete palsy will achieve a full motor recovery while <40 % of patients with a complete motor palsy will regain the ability to dorsiflex at the ankle. While neurologic interventions show promise for the future, the outcomes in knee dislocation patients remain poor. The most predictable means of reestablishing antigravity dorsiflexion in a persistent CPN palsy is a posterior tibial tendon transfer.