Rotation aiding technique for endobronchial ultrasound-guided transbronchial needle aspiration biopsy of intrathoracic lymph nodes: A complementary approach to the conventional jabbing method.

BACKGROUND: This study aimed to compare the lymph node core tissue lengths obtained via mediastinal or hilar lymphadenopathy using the complementary "rotation aiding" and conventional Jab technique. METHODS: We prospectively measured the lymph node core tissue length in patients who sequentially underwent the Jab and rotation aiding (RA) techniques between October 2012 and December 2014. Wilcoxon signed-rank test was used to compare the core tissue length and grade of diagnostic cells obtained by each technique. McNemar's test was used to compare the proportion of adequate cellularity (≥grade 2) between the aspiration techniques. RESULTS: The core tissue length of 61 lymph nodes from 43 patients (mean age: 63 years, range: 16-86 years) was analyzed. Pathological findings were consistent with malignant lesions in 25 (41%) patients and benign lesions in 36 (59%). The most common diagnosis in benign lymph nodes was reactive, followed by tuberculosis and sarcoidosis. We obtained longer core tissue with RA technique than with the Jab technique (83.2 ± 12.7 vs. 60.1 ± 10.1 mm; p = 0.02). There was a significant increase in cellularity grade and proportion of ≥grade 2 cells with the RA technique than with the Jab technique (2.39 ± 1.08 vs. 1.84 ± 1.14; p < 0.001, 78.7% vs. 52.5%; p = 0.002), regardless of the pathological diagnosis. CONCLUSIONS: RA technique facilitated more lymph node samples in terms of core tissue length and cellularity than the Jab technique.