Comparison of Sample Adequacy and Diagnostic Yield of Auto-Aspiration and Manual Aspiration Techniques in Ebus-TBNA

Abstract Background The manual aspiration technique involving high suction force is a new method for EBUS-TBNA. However, its application in EBUS-TBNA has been controversial, and consensus guidelines do not answer this specific question. Aim of the Work This study aimed to compare the diagnostic yield and sample volume of EBUS- TBNA using standard auto-aspiration and novel manual aspiration techniques. Patients and Methods 48 patients with undiagnosed mediastinal lymphadenopathy or centrally located lung tumors were randomized in a 1:1 manner into 2 equal groups regarding aspiration technique: Group 1 underwent EBUS-TBNA with standard auto-aspiration technique, and Group 2 underwent EBUS-TBNA with novel manual aspiration technique. Diagnostic yield and sample volume were compared between the two groups. Results The manual aspiration group showed significantly better diagnostic yield (p = 0.039), with a diagnosis in 91.7% of patients compared to 62.5% in the auto-aspiration group. The manual aspiration group also had a significantly higher sample volume (p < 0.001), with a mean sample volume of 12.80±1.20 mm3 compared to 9.76±1.31 mm3 in the auto-aspiration group. Conclusion The manual suction sampling technique via EBUS-TBNA achieved a higher sample volume and diagnostic yield than the auto suction sampling technique. Therefore, we suggest using manual suction sampling technique in the EBUS-TBNA procedure as it appears to be a promising, easy, no-cost, and safe technique variation. This study adds useful information to the technique of EBUS-TBNA and has potential practice-changing implications.