Endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) of lymph nodes is an effective modality in assessing mediastinal lymphadenopathy. While the diagnostic yield is high in malignant diseases, its’ sensitivity is low in sarcoidosis, which may be due to the small specimen size obtained by TBNA. Ability to perform biopsies of the lymph nodes with a forceps under real-time EBUS guidance can increase the diagnostic yield.
Patients with diffuse mediastinal lymphadenopathy and without known or suspected non-small cell carcinoma were prospectively evaluated. During EBUS procedure, the largest lymph nodes at stations 4 (R/L), 7, 10 and 11 (R/L) were identified. TBNA was performed with a 22 G needle provided with EBUS. A biliary biopsy forceps (Spybite, Boston Scientific) was advanced through the EBUS scope into the same lymph node under real-time guidance and biopsies were performed. If the patients remained undiagnosed following the procedure, they were referred for mediastinoscopy. Complications from the procedure were recorded.
Fourteen patients underwent the procedure. In the first 6 patients, the procedure was performed under general anesthesia with rigid bronchoscopy and in the subsequent patients; it was performed under conscious sedation. Sarcoidosis was confirmed in 7 patients based on lymph node biopsies. Among these 7 patients, granulomas were seen only on 3 with TBNA. Three patients were diagnosed with NSCLC based on both TBNA and the lymph node biopsy. The remaining four patients required mediastinoscopy to confirm sarcoidosis in three and lymphoma in one. Lymph nodes stations accessed with biopsy forceps included 7, 11L and 11R. No complications were noted in any of the patients.
Lymph node biopsies under EBUS-guidance are feasible and appear to provide a higher diagnostic yield compared to TBNA in patients suspected to have sarcoidosis. The procedure can be performed safely on any of the accessible stations under conscious sedation.
Forceps biopsy of lymph nodes under EBUS-guidance provides a minimally invasive option when TBNA is inconclusive and may provide an alternative to mediastinoscopy.
Chakravarthy Reddy, No Financial Disclosure Information; No Product/Research Disclosure Information