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Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

      To the Editor:
      Wahidi et al
      • Wahidi M.M.
      • Herth F.
      • Yasufuku K.
      • et al.
      Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report.
      recently published a guideline and expert panel report in CHEST (March 2016) reviewing the technical aspects of endobronchial ultrasonography (EBUS) and EBUS-guided transbronchial needle aspiration. We would like to acknowledge the authors’ thorough evidence-based review of the topic and their outstanding work in publishing the first guidelines to summarize a body of literature that has become quite large over recent years.
      We would like to point out that a retrospective study we performed concerning nasal insertion of EBUS at our institution has been incorrectly referenced and should be corrected.
      • Beaudoin S.
      • Ferland N.
      • Martel S.
      • Delage A.
      Feasibility of using the nasal route for linear endobronchial ultrasound.
      The correct reference is available in the reference list.
      Also, in the guideline statement, the authors conclude that there is no available randomized trial comparing nasal and oral EBUS scope insertion. Out of interest, we would like to mention a randomized study that we recently completed and published comparing the two routes of insertion.
      • Beaudoin S.
      • Martel S.
      • Pelletier S.
      • et al.
      Randomoized trial comparing patient comfort between the oral and nasal insertion routes for linear endobronchial ultrasound.
      A total of 110 subjects were randomized in each group. Our study did not find any significant difference regarding patient comfort, satisfaction, and willingness to repeat the procedure. The two groups also did not differ regarding EBUS-transbronchial needle aspiration diagnostic yield and specimen adequacy rate. It is worth noting that the EBUS bronchoscope could not be nasally inserted in 24.5% of patients in the nasal group. We thus concluded that both routes confer a high degree of comfort with similar complication rates and diagnostic yields.
      Although EBUS is performed mostly through the nasal route at our center, we believe both routes to be equivalent and that physician and, most importantly, patient preferences should dictate the route of insertion.

      References

        • Wahidi M.M.
        • Herth F.
        • Yasufuku K.
        • et al.
        Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report.
        Chest. 2016; 149: 816-835
        • Beaudoin S.
        • Ferland N.
        • Martel S.
        • Delage A.
        Feasibility of using the nasal route for linear endobronchial ultrasound.
        Lung. 2014; 192: 921-926
        • Beaudoin S.
        • Martel S.
        • Pelletier S.
        • et al.
        Randomoized trial comparing patient comfort between the oral and nasal insertion routes for linear endobronchial ultrasound.
        J Bronchology Interv Pumonol. 2016; 23: 39-45

      Linked Article

      • Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report
        ChestVol. 149Issue 3
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          Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians.
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      • Response
        ChestVol. 150Issue 1
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          We appreciate Delage and Beaudoin’s1 positive review of our recent published guidelines and expert panel report in CHEST on the technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration.2
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