Background Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the standard for mediastinal and hilar lymph node sampling. Traditionally, a single needle is used, which can lead to procedural downtime while specimens are processed, potentially prolonging anesthesia duration. This study aimed to determine whether using a second needle could expedite the procedure enough to offset its cost. Methods In a prospective, single-blind, multi-center, randomized controlled trial, 126 adult patients undergoing EBUS-TBNA were randomized to either one or two needles. The primary outcome was time per needle pass. Secondary outcomes included cost-benefit analysis, diagnostic yield, next-generation sequencing (NGS) sufficiency, and carbon impact. Results The two-needle group had significantly faster needle passes (56.2 ± 14.3 vs. 82.1 ± 21.9 seconds; p < 0.001), though total procedure time was not significantly different (22.2 ± 9.1 vs. 24.7 ± 12.5 minutes; p = 0.101). More needle passes were performed in the two-needle group (16.9 ± 6.5 vs. 13.9 ± 6.1; p = 0.004), with no difference in the number of lymph nodes sampled. Diagnostic yield was 96.0% overall, and NGS sufficiency in cancer cases was 93.6%, with no differences between groups. Interpretation Using a second needle decreases time per needle pass without changing overall procedure time or compromising diagnostic performance. Although it increases immediate cost a customizable model was developed to help centers determine when the time savings justify the added expense, based on anesthesia cost, needle price, and planned passes per node.
Kapp et al. (Tue,) studied this question.