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Study of Procedural Efficiency in Endobronchial Ultrasound with Dual versus Single NEEDLEs: Evaluating the Value of a Second Needle in Endobronchial Ultrasound as It Pertains to Economic and Environmental Impact
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DOI：10.1159/000551855.png)
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Abstract
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Introduction: 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 1 or 2 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 s; p < 0.001), though total procedure time was not significantly different (22.2 +/- 9.1 vs. 24.7 +/- 12.5 min; 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. Conclusion: Using a second needle decreases time per needle pass without changing overall procedure time or compromising diagnostic performance. Although it increases immediate cost and environmental impact, 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.
Keywords:
Endobronchial ultrasound
Transbronchial needle aspiration
Business of bronchoscopy
Environmental impact of bronchoscopy
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