Background: The optimal procedure for maximizing the diagnostic yield and minimizing the procedural complexity\nof endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is controversial. We conducted a\nprospective randomized controlled trial to determine the optimal procedure of EBUS-TBNA for mediastinal and hilar\nlymphadenopathy, with a particular focus on the roles of the inner-stylet and suction.\nMethods: Consecutive patients with enlarged mediastinal and hilar lymph nodes (LNs), detected by computed\ntomography (CT) or positron emission tomography-CT (PET-CT), who underwent EBUS-TBNA were included. Each LN\nwas sampled with three needle passes using suctionâ??stylet, suctionâ??no stylet, and styletâ??no suction procedures. The\nsamples were smeared onto glass slides for cytological evaluation. A single, blinded cytopathologist evaluated each set\nof slides. The primary outcomes were cytological specimen adequacy rate and diagnostic yield of malignant LNs. The\nsecondary outcomes were tissue-core acquisition rate, procedural time, and the amount of bleeding.
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