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Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
Published on: November 10, 2014
EBUS-guided transbronchial mediastinal cryobiopsy for diagnosing non-metastatic lymphadenopathy: A randomized
Mingming Deng1, Ziwen Zheng2, Xiaofei Zhang3
1National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China.
Background:
Non-metastatic lymphadenopathy is challenging to diagnose. The comparative diagnostic performance of endobronchial ultrasound (EBUS)-guided transbronchial mediastinal cryobiopsy (TBMC) vs. EBUS-transbronchial needle aspiration (TBNA) remains debated.
Methods:
This multicenter randomized trial was conducted in three hospitals. Patients with at least one mediastinal and/or hilar lesion of ≥1 cm in the short axis who required diagnostic bronchoscopy were included. The patients were randomized in a 1:1 ratio to receive either EBUS-TBNA followed by EBUS-TBMC (EBUS-TBNA-first group) or EBUS-TBMC followed by EBUS-TBNA (EBUS-TBMC-first group). The primary outcome was the diagnostic yields of EBUS-TBMC and EBUS-TBNA.
Findings:
The overall diagnostic yield of EBUS-TBMC for non-metastatic lymphadenopathy was significantly higher than that of EBUS-TBNA for specific benign etiologies and lymphomas (97.1% vs. 79.9%, p < 0.001). In the subgroup analysis, EBUS-TBMC showed a higher sensitivity for sarcoidosis than EBUS-TBNA (98.0% vs. 82.7%, p < 0.001). All patients experienced grade 1 airway bleeding.
Conclusions:
EBUS-TBMC demonstrated a higher diagnostic yield than EBUS-TBNA for non-metastatic lymphadenopathy in a cohort almost exclusively composed of sarcoidosis cases, with a good safety profile. EBUS-TBMC is a potential first-line diagnostic tool for non-metastatic lymphadenopathy.
Funding:
This work was financially supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0528900 and 2024ZD0528902 to G.H.).
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