Eb 530us

All patients underwent EBUS‐TBNA orally under local anesthesia. Methods of local anesthesia are described below. In our institution, midazoram 0.03–0.06 mg/kg and fentanyl 0.8–1 μg/kg are initially administered. Specifically, 10 mg midazolam and 100 μg fentanyl were diluted to 10 ml with saline and administered during the procedure. The dose was increased at the discretion of the bronchoscopist according to the patient's anesthetic depth (to maintain less than +1 on the RASS scale). SpO₂ and heart rate were monitored in all patients and oxygen was administered to keep the SpO2 above 90% during EBUS‐TBNA.
The method of EBUS‐TBNA was in accordance with the British Thoracic Society guidelines,⁹ apart from the size of the needle, number of biopsies, and biopsy sites, which were left to the attending physician's discretion. Bronchoscopes used were the Olympus BF‐UC290F (Olympus), BF‐UC260‐OL8 (Olympus), or EB‐530US (Fujifilm). After removing the stylet, the specimen was collected by aspiration using a syringe while manipulating the needle back and forth approximately 10 times in the lesion.

EBUS‐TBNA was performed with a convex ultrasound bronchoscope (EB530US; Fujifilm, Tokyo, Japan) and a 21‐gauge EBUS needle (NA‐U401SX‐4025N; Olympus, Tokyo, Japan). The target lymph nodes were visualized with EBUS; then, the Doppler blood flow instrument was used to assess blood flow around and within the lymph nodes. Needle passes were provided for 20–30 times during one puncture. After assessing for hemostasis, EBUS‐TBNA was reperformed several times until a sample with adequate volume was obtained. The tissue samples were pushed out from the needle using a stylet. These samples were then immediately fixed in 10% neutral‐buffered formalin. All procedures were not performed without ROSE.