Effect of the Number of Needle Revolutions Inside the Node on the Diagnostic Yield of EBUS-TBNA in Sarcoidosis
Effect of the Number of Needle Revolutions Inside the Node on the Diagnostic Yield of EBUS-TBNA in Sarcoidosis
The investigators plan to evaluate the effect of the number of needle revolutions inside the
 node on the diagnostic yield of endobronchial ultrasound-guided transbronchial needle
 aspiration (EBUS-TBNA) in patients with sarcoidosis.
Sarcoidosis is a multisystem disorder of unknown etiology characterized by granulomatous
 inflammation involving various body organs. The diagnosis is made on the basis of compatible
 clinicoradiological feature, histopathologic evidence of non-caseating granuloma, and
 exclusion of other known causes for granulomatous inflammation. As the lung and mediastinal
 lymph nodes are the most commonly involved structures in sarcoidosis, various bronchoscopic
 techniques like endobronchial biopsy (EBB), transbronchial biopsy (TBLB) and transbronchial
 needle aspiration (TBNA) are needed for tissue sampling.

 Among the bronchoscopic techniques, TBNA of lymph nodes has emerged as the most useful
 modality in addition to the previously known endobronchial and transbronchial biopsies. The
 efficacy and safety of conventional TBNA are well established. With improvements in
 technology, last decade has seen the use of EBUS to guide transbronchial needle aspiration.
 This technique is a minimally invasive and offers the additional advantage of choosing the
 appropriate node for sampling based on the vascularity, echogenicity and size. Studies
 subsequently have demonstrated the superiority EBUS-TBNA over conventional TBNA.

 Once the role of TBNA in diagnostic bronchoscopy was clear, technical aspects of the
 procedure became the topic of research. This includes the number of aspirations or passes
 required per lymph node station, needle gauge (21 vs. 22 gauge), suction pressure, and the
 distance travelled by the needle within the lymph node. The number of revolutions i.e. the
 number of times the needle should be moved back-and-forth inside the lymph node is one such
 factor. The recommendation is to move the needle ten to twenty times. However the optimum
 number of times the needle should be moved back and forth for extracting adequate tissue
 material has not been studied to date. The investigators have observed that performing
 revolutions during EBUS-TBNA frequently leads to aspiration of blood during the procedure.

 The investigators hypothesize that the number of revolutions will not affect the diagnostic
 yield, and the yield would be similar in 10 compared to 20 revolutions. In this study, the
 investigators plan to evaluate the effect of the number of needle revolutions inside the node
 on the diagnostic yield of EBUS-TBNA in patients with sarcoidosis.
Inclusion Criteria:

 -  Age group of 18 to 65 years

 -  Clinicoradiological suspicion of sarcoidosis where EBUS-TBNA is being planned

 -  Enlarged hilar and mediastinal lymph nodes >10 mm (any axis) on computed tomography of
 the chest

 Exclusion Criteria:

 -  Hypoxemia (SpO2 <92% on FiO2 of 0.3)

 -  Treatment with systemic glucocorticoids for >2 weeks in the preceding three months

 -  Diagnosis of sarcoidosis possible with another minimally invasive technique such as
 skin biopsy or peripheral lymph node biopsy

 -  Failure to provide informed consent.