An RCT of 19G EBUS-TBNA Needle in Suspected Sarcoidosis

NCT ID: NCT04770948

Last Updated: 2023-11-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-01

Study Completion Date

2023-09-30

Brief Summary

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Sarcoidosis is an idiopathic disorder characterized by granulomatous inflammation involving various organ systems. The lung and mediastinal lymph nodes are the most commonly involved structures in sarcoidosis. In the presence of intrathoracic lymph nodes, transbronchial needle aspiration (TBNA) is a useful diagnostic modality, which is now guided using endobronchial ultrasound (EBUS).

We hypothesize that the 19-gauge EBUS-TBNA needle will have a higher yield as compared to the conventional 22-gauge EBUS-TBNA needle in intrathoracic lymphadenopathy due to sarcoidosis. In this study, we plan to evaluate the yield and safety of the 19-gauge needle vs. the conventional 22-gauge EBUS-TBNA needle in patients with sarcoidosis.

Detailed Description

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Sarcoidosis is an idiopathic disorder characterized by granulomatous inflammation involving various organ systems. The disease is diagnosed based on a suggestive clinicoradiological picture and the presence of non-caseating granulomas in the involved organ, after excluding known causes of granulomatous inflammation. The lung and mediastinal lymph nodes are the most commonly involved structures in sarcoidosis. Various bronchoscopic techniques such as endobronchial biopsy (EBB), transbronchial biopsy (TBLB) and transbronchial needle aspiration (TBNA) are commonly used for acquiring tissue samples.

In the presence of intrathoracic lymph nodes, TBNA is a useful diagnostic modality, especially when combined with endobronchial and transbronchial biopsies. At most centers, TBNA is now guided using endobronchial ultrasound (EBUS). The technique is minimally invasive and also offers the advantage of a selection of the appropriate node for sampling based on the ultrasonographic characteristics. Several studies have demonstrated the superiority of EBUS-TBNA over conventional TBNA (TBNA performed without real-time guidance).

Several technical aspects of EBUS-TBNA have been studied to optimize the yield including the number of aspirations or passes required per lymph node station, needle gauge (21 vs. 22 gauge), suction pressure, the distance travelled by the needle within the lymph node, the number of needle agitations required during a pass, and others.

The novel 19-G Vizishot FLEX EBUS needle (Olympus) is composed of a more flexible material (nitinol) than the 22-G EBUS needle. This allows it to have a larger inner diameter with the same outer diameter as a 22-G EBUS needle. Recent studies have shown that the 19-G needle is safe and has a comparable yield to smaller bore needles. In case of suspected lymphadenopathy due to malignant disorders, aspiration using smaller gauge needles may yield sufficient material for diagnosis. However, in sarcoidosis, larger nodal tissue obtained with a thicker bore needle, the 19-gauge needle, may potentially increase the identification of granulomas. We hypothesize that the 19-gauge EBUS-TBNA needle will have a higher yield as compared to the conventional 22-gauge EBUS-TBNA needle in intrathoracic lymphadenopathy due to sarcoidosis. In this study, we plan to evaluate the yield and safety of the 19-gauge needle vs. the conventional 22-gauge EBUS-TBNA needle in patients with sarcoidosis.

Conditions

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Sarcoidosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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19G

19 gauge EBUS-TBNA needle

Group Type EXPERIMENTAL

19 gauge needle

Intervention Type DEVICE

EBUS-TBNA performed using 19G needle

22G

22 gauge EBUS-TBNA needle

Group Type ACTIVE_COMPARATOR

22 gauge needle

Intervention Type DEVICE

EBUS-TBNA performed using 22G needle

Interventions

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19 gauge needle

EBUS-TBNA performed using 19G needle

Intervention Type DEVICE

22 gauge needle

EBUS-TBNA performed using 22G needle

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age at least 18 years
* Clinicoradiological suspicion of sarcoidosis where EBUS-TBNA is being planned
* Enlarged bilateral hilar and/or mediastinal lymph nodes \>10 mm (any axis) on computed tomography of the chest
* Ability to provide informed consent to participate in the study.

Exclusion Criteria

* Asymmetric lymph nodes
* Lymph nodes with significant hypodense areas suggestive of necrosis
* Tuberculin skin test \>10 mm
* Hypoxemia (SpO2 \<92% on FiO2 of 0.3)
* Treatment with systemic glucocorticoids for \>2 weeks in the preceding three months
* Diagnosis of sarcoidosis possible with another minimally invasive technique such as skin biopsy or peripheral lymph node biopsy
* Failure to provide informed consent.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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All India Institute of Medical Sciences

OTHER

Sponsor Role collaborator

Apollo Hospitals Enterprise Limited

OTHER

Sponsor Role collaborator

Jaipur Golden Hospital, New Delhi

UNKNOWN

Sponsor Role collaborator

Rajiv Gandhi Cancer Institute & Research Center, India

OTHER

Sponsor Role collaborator

Institute of Pulmonology, Medical Research, and Development, Mumbai

UNKNOWN

Sponsor Role collaborator

All India Institute of Medical Sciences, Bhopal

OTHER

Sponsor Role collaborator

Asian Institute of Gastroenterology, Hyderabad

UNKNOWN

Sponsor Role collaborator

Yashoda Hospitals, Hyderabad

UNKNOWN

Sponsor Role collaborator

City Clinic and Bhailal Amin General Hospital, Vadodara

UNKNOWN

Sponsor Role collaborator

Post Graduate Institute of Medical Education and Research, Chandigarh

OTHER

Sponsor Role lead

Responsible Party

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Ritesh Agarwal

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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PGIMER

Chandigarh, , India

Site Status

Countries

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India

Other Identifiers

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SPL822

Identifier Type: -

Identifier Source: org_study_id