Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the standard procedure for the initial diagnosis and staging of lung cancer; however, there is limited guidance on how to handle and process specimens during and after acquisition to enhance both diagnostic yield and specimen preservation for subsequent ancillary testing. Given the significant variation in sample collection practices among different institutions, a new clinical guideline on EBUS-TBNA now aims to utilize the experiences of both pulmonologists and pathologists to standardize the process.

The strength of evidence regarding the handling and processing of EBUS-TBNA specimens varies, but there is sufficient information in some areas to assist clinicians with specific aspects of specimen handling. The American College of Chest Physicians (CHEST, Glenview, IL, USA) has published a new clinical guideline on EBUS-TBNA, which strongly recommends performing four or more needle passes instead of three or fewer in patients suspected of having malignant disease undergoing EBUS-TBNA. The guideline also advises utilizing rapid on-site evaluation rather than standard care for patients with suspected malignancies undergoing EBUS-TBNA. Furthermore, for patients suspected of having malignant disease, the guideline recommends using a smaller needle (21 gauge or 22 gauge) instead of a larger one (19 gauge). The complete list of recommendations outlined in the new guideline can be accessed through the CHEST journal website. 

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