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In Reply: Dr Navani and colleagues raise the issue of the optimal number of passes of the TBNA needle into each lymph node. In one study, up to 7 TBNA passes were needed to maximize the sensitivity, although in that study more than 80% of positive diagnoses were obtained by the third FNA pass.¹ Another study of the relationship between number of passes and sensitivity using EUS-FNA found that 3 passes were needed to maximize the sensitivity.² Given the need to make a fair head-to-head comparison, we chose a uniform number of passes (at least 3) for all 3 procedures. We accept that more passes by TBNA may have increased the yield, and it is appropriate in settings where EUS-FNA or EBUS-FNA are not available. Similarly, the use of ROSE is most helpful when ultrasound guidance is not available but does increase the cost and time needed for the procedure. . . . [Full Text of this Article]

Michael B. Wallace, MD, MPH
wallace.michael@mayo.edu
Department of Medicine
Mayo Clinic
Jacksonville, Florida

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