The introduction of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the early 2000s has significantly transformed the evaluation of lung cancer and intrathoracic disorders. According to the American College of Chest Physicians (CHEST) lung cancer guidelines, EBUS-TBNA demonstrates a median sensitivity of 89% and a negative predictive value of 91%. Consequently, it is recommended as the preferred initial approach for mediastinal staging during lung cancer evaluation, replacing surgical staging techniques.
As EBUS-TBNA has gained widespread adoption, questions regarding optimal specimen handling have emerged, highlighting the need to maximize patient outcomes. Existing guidelines provide recommendations on when and how to perform EBUS-TBNA but offer limited guidance on managing specimens after retrieval.
The goal of this CHEST report is to explore the current knowledge surrounding the acquisition, handling, and processing of EBUS-TBNA specimens in both malignant and non-malignant diseases. Instead of addressing decisions on when or how to perform the procedure, this report focuses primarily on the processes involved in specimen retrieval and management.
- In patients undergoing EBUS-TBNA, it is advised to use either standard clinical practice (stylet, air) or alternative methods (needle rinse) for specimen sample expulsion.
- For patients with suspected malignant disease undergoing EBUS-TBNA, either alternative collection media (formalin, RPMI, saline, phosphate-buffered saline) or standard alcohol-based preparations can be utilized.
- In cases of suspected malignant disease, rapid onsite evaluation (ROSE) is preferred over usual care during EBUS-TBNA.
- A smaller needle (21 gauge or 22 gauge) is generally recommended over a larger needle (19 gauge) for patients with suspected malignant disease undergoing EBUS-TBNA.
- Performing 4 or more needle passes is recommended over 3 or fewer passes in patients with suspected malignant disease undergoing EBUS-TBNA.
- For patients with suspected non-malignant disease, using either alternative collection media (formalin, RPMI, sterile saline, phosphate-buffered saline) or standard alcohol-based preparations is appropriate during EBUS-TBNA.
- Rapid onsite evaluation (ROSE) is encouraged over usual care for patients with suspected non-malignant disease undergoing EBUS-TBNA.
- Either a smaller needle (21 gauge or 22 gauge) or a larger needle (19 gauge) can be used in patients with suspected non-malignant disease undergoing EBUS-TBNA.
- For patients with suspected non-malignant disease, 4 or more needle passes are favored over 3 or fewer during EBUS-TBNA.
This report offers evidence-based guidance on handling and processing EBUS-TBNA specimens for bronchoscopists. With support from CHEST methodologists, a thorough review of the literature was conducted to address key questions. Recommendations were made based on the strength of available evidence, while topics lacking sufficient data were addressed through expert consensus. Despite some evidence in this area, gaps remain, particularly regarding aspects of specimen handling that may influence EBUS-TBNA outcomes. As molecular and ancillary testing advances in oncology, optimizing specimen management with limited tissue will become increasingly important.