Endobronchial ultrasound needles: does size matter?

Endobronchial ultrasound guided sampling is a commonly performed endoscopy procedure. Despite its widespread use, the technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration, including the selection of needle size, have not been standardized among operators or institutions. Furthermore, professional guidelines are vague regarding their recommendations in choosing a needle size for optimal sampling. Various factors such as operator training, type of needle, use of suction, needle-tissue interaction, sample handling, processing, and presence of rapid on-site cytopathologic evaluation may impact the diagnostic yield. This review focuses on the various needle sizes used in endobronchial ultrasound-guided transbronchial needle aspiration, specifically comparing diagnostic accuracy and adequacy of tissue sampling, with a focus on use in lung malignancy, sarcoidosis, and lymphoproliferative disorders. Additionally, the advantages and limitations of different needle sizes will be addressed.