Background. Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure to evaluate hilar and mediastinal lymph nodes (LN). Slow-pull (SP) and suction (S) techniques are two different sampling methods and their DY and SA in literature are still debated.

Aim. To compare DY and SA for predictive markers of SP and S techniques.

Methods. 156 patients with lymphadenopathy were consecutively enrolled from February 2022 to December 2022. Positron emission tomography computed tomography (PET/CT) and/or chest CT scan were performed to evaluate LN. Dimension at imaging and standardized uptake value (SUV) were recorded. EBUS-TBNA was performed with crown-cut needles (Acquire FNB device, Boston Scientific Co., Natick, MA). DY and SA for predictive markers were evaluated. 

Results. S was used in 129 patients and SP was used in 27, with no differences in sex, age and CT LN dimension (male 63% vs 67%, p=0.7; 68 vs 73 years, p=0.14; 20 vs 20 mm, p=0.8). DY and SA for predictive markers were not statistically significant between S and SP (88% vs 100%, p=0.07; 70% vs 59%, p=0.27), whereas the frequency of use of 22G needle size was significantly different between S and SP (62% vs 85%, p=0.02).

Conclusions. S and SP either present a very high DY and SA when crown-cut needle is used. SP has a DY of 100%, even if not statistically significant compared to S. When 22G needle is used, SP is the preferred technique. Further studies are needed to evaluate if SP can be performed with smaller needles and if a standardized EBUS-TBNA sampling is possible with these needles.