Role of EBUS-IFB in Providing High-quality Pathological Samples for a Sarcoidosis Diagnosis

Objective　Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard procedure for diagnosing mediastinal and hilar lymphadenopathy, its diagnostic yield for sarcoidosis remains suboptimal due to nodal fibrosis. Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) has emerged as a promising adjunctive technique; however, concerns remain regarding the potential for crush artifacts when using mini-forceps. This study aimed to evaluate the histological specimen quality, diagnostic utility, and safety of EBUS-IFB in patients with suspected sarcoidosis in a single institution.Methods　We retrospectively analyzed 11 consecutive patients with suspected sarcoidosis who underwent EBUS-IFB after EBUS-TBNA at a single center. We assessed the specimen quality, diagnostic yield, and safety. Two pathologists independently evaluated the specimens using a validated scoring system focusing on the amount of cellular material, background blood, degree of cellular degeneration and trauma, and retention of normal architecture.Results　EBUS-IFB yielded significantly higher-quality specimens than EBUS-TBNA (median total score, 7.0 vs. 4.0; p = 0.01). Notably, EBUS-IFB specimens demonstrated well-preserved tissue architecture without significant crush artifacts and significantly less blood contamination (p = 0.006). The overall diagnostic yield was 81.8% (9 of 11), and definitive diagnoses of sarcoidosis were obtained by EBUS-IFB alone in six cases. No procedure-related complications were noted.Conclusions　Despite concerns regarding crush artifacts, EBUS-IFB provides high-quality, structurally intact histological specimens with minimal blood contamination compared to EBUS-TB. EBUS-IFB is a safe and effective adjunctive modality that successfully compensates for the limitations of fine-needle aspiration in sampling fibrotic lymph nodes.