A novel technique using diode laser-assisted endobronchial ultrasound-guided transbronchial biopsy: a brief report

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains the standard minimally invasive approach for diagnosing and staging thoracic pathology, yet needle aspiration alone often yields limited sensitivity and insufficient tissue for molecular profiling, and while forceps and cryobiopsy techniques can improve diagnostic yield, advancing conventional instruments to a target lesion is not always technically feasible. We report our institutional experience using a 1,470 nm diode laser as an adjunct to EBUS-guided transbronchial tissue acquisition to overcome these access limitations and enhance diagnostic yield. We performed a single-center retrospective case series of patients undergoing laser-assisted EBUS-guided transbronchial cryobiopsy (LA-EBUS-TBCB) or forceps biopsy (LA-EBUS-TBFB) following Institutional Review Board approval, with collected variables including patient demographics, procedural indications, lesion characteristics, laser parameters, diagnostic adequacy, and complications; reporting followed the Preferred Reporting of Case Series in Surgery (PROCESS) 2023 guidelines. Forty-seven patients (mean age 63.9 years; 53.1% male) underwent laser-assisted EBUS-guided biopsy using forceps, cryoprobe, or both, predominantly for diagnostic purposes (87.2%), with lymph node sampling performed in 76.5% of cases, most frequently targeting station 7 (40.4%) and station 4R (31.9%). All procedures used a 1,470 nm diode laser, most commonly at 1-watt power (63.8%). Diagnostic adequacy on pathology review was achieved in 93.6% of cases (44/47), compared with 85.1% (40/47) by cytology alone, an absolute improvement of 8.5 percentage points that recovered definitive tissue diagnoses in 4 of 7 otherwise non-diagnostic cases, and no laser-related bleeding, bronchospasm, airway injury, or fire events occurred. These findings suggest that laser-assisted EBUS-guided transbronchial biopsy using a 1,470 nm diode laser is safe and technically feasible, with high diagnostic adequacy and a favorable complication profile, and may help overcome access limitations encountered with conventional instrumentation, though larger prospective studies are warranted to validate these results, optimize procedural parameters, and define its role relative to standard EBUS-TBNA techniques.