In response

In a recent issue of CHEST (January 2011), Gounant et al 1 showed that dedicated linear echoendoscope endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needles are able to release metal particles, probably by friction between the stylet and the needle, with a potential risk of injecting particles into nodes. After reading this article, we are a bit confused for several reasons. First, we do not understand the primum movens and the intrinsic aim of designing a study like this. Logically, we should perform similar investigations on all surgical, endoscopic, and radiologic procedures in which metal tools are used. Indeed, a simple blood test with a needle could release metal particles. Therefore, we do not understand the need to focus specifi cally on dedicated EBUS-TBNA needles. Second, the article does not indicate the concentrations of iron, titanium, nickel, and chromium that can be potentially harmful to the body. This is important information, considering how many times a patient may undergo EBUS-TBNA over a lifetime (one, maybe two times). Accordingly, we have some doubts that the concentrations released in the lymph nodes are so high as to be potentially harmful to the body. In conclusion, we completely agree with the authors that transbronchial needle aspiration using a fl exible bronchoscope (conventional transbronchial needle aspiration) or linear echoendoscope (endobronchial ultrasound) allowing real-time guided lymph node aspiration are minimally invasive procedures for the diagnosis of mediastinal lymphadenopathy, with a very high sensitivity, a very low morbidity, and no reported mortality. 2 , 3 Although the release of metal particles by an EBUS-TBNA needle may be reported to the manufacturers of these needles, this must not lead to a reduction in, or questioning of, the use of EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy.