Miniforceps EBUS-guided lymph node biopsy: impact on diagnostic yield.

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Diagnostic Cytopathology

Background:

• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is standard for mediastinal/hilar lymph node sampling.
• Non-diagnostic EBUS-TBNA samples necessitate improved diagnostic yield strategies.
• Endobronchial ultrasound-guided transbronchial forceps biopsy (EBUS-TBFB) is explored as an adjunct to EBUS-TBNA.

Purpose of the Study:

• To evaluate the impact of adding EBUS-TBFB to EBUS-TBNA.
• To assess diagnostic yield in cases with negative or non-diagnostic Rapid On-site Evaluation (ROSE).

Main Methods:

• Retrospective chart review of 91 patients aged 18-90.
• Patients underwent both EBUS-TBNA and EBUS-TBFB between January 2013 and July 2018.

Main Results:

• No significant difference in diagnostic yield between TBNA and TBFB (McNemar p=0.167).
• TBFB sensitivity and specificity were 87% and 69% respectively, using TBNA as gold standard.
• TBFB provided additional diagnoses in 16% of non-diagnostic TBNA cases, including granulomatous diseases and two malignancies (small cell carcinoma, non-Hodgkin's lymphoma).

Conclusions:

• EBUS-TBFB is a valuable adjunctive tool for diagnosing non-malignant conditions like granulomatous diseases.
• This technique can potentially spare patients from more invasive surgical biopsies.
• Training future pulmonologists in EBUS-TBFB is recommended to enhance diagnostic capabilities.