Franseen needle in endobronchial ultrasound-guided transbronchial needle aspiration: a phase II prospective study

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been used to diagnose and stage lung cancer. Acquire™ Pulmonary and Expect™ Pulmonary dedicated EBUS-TBNA needles were introduced as the Franseen and Lancet needles, respectively. It is still unclear whether the Franseen or Lancet needles yield a higher quality specimen especially focusing on next-generation sequencing-based molecular testing.

Methods: A single-center, prospective study performed at the Chiba University Hospital randomly assigned patients to two groups: Group A, wherein the first and second EBUS-TBNA were performed using Lancet and Franseen needles, respectively, and Group B, wherein the first and second EBUS-TBNA were performed using Franseen and Lancet needles, respectively. Each specimen was compared and analyzed pathologically. The primary outcome was the histological tissue area except blood clot and the cellularity of each sample. We also examined the success rate of molecular testing.

Results: Twelve patients who underwent EBUS-TBNA between November 2022 and February 2023 were enrolled in this study. The tissue area of the specimens obtained by the Franseen and Lancet needles was 13.3 ± 6.4 mm2 and 10.6 ± 6.3 mm2, respectively (P = .355). The tumor cellularity in the specimens obtained using the Franseen and Lancet needles was 54.0 ± 30.3 and 46.2 ± 36.3%, respectively (P = .608). The success rate of molecular testing using the single-pass sample by Franseen needle was 85.7 and 57.1% by Lancet needle. No serious complications were reported.

Conclusions: The Franseen needle tended to show a greater amount of specimen with higher tumor cellularity than the Lancet needle which may contribute higher success rate of molecular testing. Further studies must be conducted to validate the results of this study.

Key findings: What is known and what is new? What is the implication, and what should change now?

Keywords: bronchoscopy; endobronchial ultrasound (EBUS); lung cancer; next-generation sequencing (NGS); transbronchial needle aspiration (TBNA).

Figure 1

(A) The acquire™ pulmonary with a Franseen needle. (B) The expect™ pulmonary with a lancet needle. Images were provided by Boston Scientific and reprinted with permission.

Figure 2

Flow diagram for study participants. Two samples in group B were excluded and outcome analysis was performed using the remaining 10 cases.

Figure 3

Histopathological images: Hematoxylin and eosin staining (×100). (A) Specimen obtained by the Franseen needle. (B) Specimen obtained by the lancet needle. (A) has a larger tissue area and higher tumor cellularity than image B.