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Although it can be expelled spontaneously,7 an invasive method may be required when the needle cannot be reached by bronchoscopy. Otherwise, the needle may perforate or migrate to the vascular system or cause chronic inflammation as a response to a foreign object. Only in 7 of the 22 cases reported did the needle break after the adenopathy was punctured [locations 7 (3 patients), 4L (2), 4R (1) and 10R (1)]. The potential causes of needle breakage include7: (1) tangential position of the needle due to the angle required for puncture; (2) harder than usual cartilaginous rings or lymph nodes; (3) manufacturing defects of the needle. To prevent this complication, excessive angulation of the needle should be avoided and its structural integrity should be checked prior to each puncture. The needle can also break and remain retained within the sheath.8 In this case, when the sheath is extracted from the working channel and the stiffening wire is inserted, the broken distal end of the needle will be expelled. Needles generally break prior to the procedure. The lesson learned from this experience is that, although EBUS is a safe technique, complications -such as transbronchial puncture needle breakage -may arise. The structural integrity of the needles should be checked throughout the procedure and upon completion. The needle must be extracted. If it cannot be recovered by conventional bronchofibroscopy, an invasive method will be required.

Treatment of advanced EGFR-mutant NSCLC patients: Sequencing matters