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Electrocautery Knife Incisions During EBUS-Guided Miniforceps Biopsies FREE TO VIEW

Kyle Bramley, MD; Margaret Pisani, MD; Jonathan Puchalski, MD
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Yale School of Medicine, New Haven, CT

Chest. 2013;144(4_MeetingAbstracts):84A. doi:10.1378/chest.1703769
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SESSION TITLE: Novel Bronchoscopic Treatments

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) has a high diagnostic yield for non-small cell lung cancer, but the yield for sarcoidosis and lymphoma appears lower. Several authors have described EBUS-guided miniforceps biopsies to obtain more tissue than needle biopsies used in TBNA. One obstacle is an inability to pass through the mucosa due to the relatively blunt nature of the forceps compared to the needle. We hypothesized that this could be accomplished using a small endobronchial incision created by an electrocautery knife.

METHODS: We prospectively enrolled 20 patients in whom convex probe EBUS was being performed into our IRB-approved thoracic database study. We evaluated lymph nodes > 5 mm in size routinely with a 22-gauge EBUS-TBNA needle, and followed the EBUS-TBNA with miniforceps biopsies for lymph nodes > 10 mm using the 1.2 mm SpyBite™ forceps (Boston Scientific). For nodes we could not enter with the biopsy forceps, an electrocautery knife (Olympus; 40W) was employed to make a small incision under EBUS-guidance. Thereafter, the biopsy forceps were advanced through the incision into the lymph node. Complications were recorded, and a 1-week follow-up interview was conducted to assess complications not immediately observed during the procedure.

RESULTS: We evaluated 68 lymph nodes in 20 patients. Of these, 38 met size criteria and underwent forceps biopsies in addition to EBUS-TBNA biopsies. We were unable to initially pass the forceps biopsies into 15 lymph nodes and therefore a small mucosal incision was made using an electrocautery knife. Of these, 12 yielded diagnostic material (80%). No complications were observed.

CONCLUSIONS: EBUS-guided miniforceps biopsies may be difficult to pass into lymph nodes, despite using the same tract as the TBNA needle. Mucosal incisions made with an EBUS-guided electrocautery knife improve the ability to penetrate the node without compromising safety.

CLINICAL IMPLICATIONS: Electrocautery knife incisions may allow for a broader use of EBUS-guided mediastinal forceps biopsies. Additional studies are warranted to further assess safety of using electrocautery and to determine whether different biopsy forceps improve diagnostic yield.

DISCLOSURE: The following authors have nothing to disclose: Kyle Bramley, Margaret Pisani, Jonathan Puchalski

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