PURPOSE: Endobronchial ultrasound (EBUS) has significantly increased the diagnostic yield of transbronchial needle aspiration (TBNA) for centrally located thoracic abnormalities, particularly in cases of non-small cell lung carcinoma. EBUS-miniforceps biopsy (MFB) is a technique used to obtain core biopsy specimens for histopathologic examination using the convex probe EBUS bronchoscope. The diagnostic yield of EBUS-MFB has not been prospectively studied for mediastinal and hilar lymph node stations.
METHODS: Patients presenting with mediastinal and/or hilar lymphadenopathy in the absence of pulmonary parenchymal lesions underwent EBUS-TBNA followed by EBUS-MFB of involved lymph node stations. The feasibility, safety, and diagnostic yield of EBUS-MFB following EBUS-TBNA were prospectively evaluated.
RESULTS: A total of 49 paratracheal, subcarinal, and hilar lymph nodes in 33 patients were sampled. A diagnosis was obtained in 44/49 (90%) lymph nodes with EBUS-MFB and 40/49 (82%) lymph nodes with EBUS-TBNA. This difference in yield did not reach statistical significance (p=.206). Combining TBNA and MFB resulted in a diagnosis in 47/49 (96%) of lymph nodes sampled. Per patient, a diagnosis was made in 30/33 (91%) patients with EBUS-MFB, in 29/33 (88%) patients with EBUS-TBNA, and in 32/33 (97%) patients when the two techniques were combined. In cases of lymphoma, EBUS-TBNA was non-diagnostic in 3/3 (0%) lymph nodes and EBUS-MFB was diagnostic in 3/3 (100%) lymph nodes. There were no complications directly related to either MFB or TBNA.
CONCLUSION: EBUS-miniforceps biopsy is a safe and effective method to obtain histopathologic core specimens from mediastinal and hilar lymph node stations. EBUS-MFB appears as effective as EBUS-TBNA for the diagnosis of mediastinal and hilar abnormalities and the combination of the two methods may be superior to either method alone. EBUS-MFB may also be superior to EBUS-TBNA for the diagnosis of lymphoma.
CLINICAL IMPLICATIONS: EBUS-miniforceps biopsy may complement and improve the diagnostic yield of EBUS-TBNA and should be considered when evaluating patients with mediastinal and hilar lymphadenopathy in the absence of pulmonary parenchymal lesions, particularly in cases in which lymphoma is a consideration.
DISCLOSURE: Ara Chrissian, No Financial Disclosure Information; No Product/Research Disclosure Information