Endobronchial ultrasound‐guided mediastinal lymph node forceps biopsy in patients with negative rapid‐on‐site‐evaluation: A new step in the diagnostic algorithm

Abstract

Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) provides a high diagnostic yield in lung cancer, but the yield for benign conditions and lymphoma is lower. The material obtained by EBUS‐TBNA is limited by the lack of histopathological samples in some cases. The current ‘expanded’ aims of mediastinal lymph node (MLN) sampling are both an accurate diagnosis and adequate material for ‘targeted’ processing in malignant and benign disease. The sample obtained with the 21/22G EBUS needle may not be sufficient in all situations. Objectives The aim of the study was to evaluate the role of a novel technique for EBUS‐guided MLN forceps biopsy (EBUS‐TBFB) when EBUS‐TBNA with rapid on‐site‐evaluation (ROSE) failed to provide a diagnosis. In addition, the technical aspects and safety of EBUS‐TBFB were studied. Methods About 30 consecutive patients with enlarged MLN, with a negative EBUS‐TBNA ROSE were included. EBUS‐TBFB was done by the method described below. The histopathology and complications were recorded. Results Adequate samples for analysis were obtained in all the patients with both EBUS‐TBNA and EBUS‐TBFB. In patients with a non‐diagnostic EBUS‐ROSE, EBUS‐TBFB led to positive diagnostic results in an additional 8/30 patients (27%). Mild bleeding was noted in two patients who underwent EBUS‐TBFB, which resolved with conservative management. The procedure was safe with no major complications. Conclusion In patients with a negative EBUS‐ROSE, EBUS‐TBFB using this technique is safe and augments the diagnostic yield. EBUS‐TBFB adds to the armamentarium of EBUS, especially in benign aetiologies of MLN enlargement.

Endobronchial Ultrasound-Guided Transbronchial Forceps Biopsy: A Retrospective Bicentric Study Using the Olympus 1.5 mm Mini-Forceps

“…However, the outer diameter of both needles is identical, and this supposition will require further study. Mehta et al used a flexible electrocautery knife to create a tract for the forceps with a successful penetration of the bronchial wall [ 20 ]. This might be a proper solution to overcome this limitation in future studies.…”

“…In 2012, Herth et al demonstrated that using a 1.5 mm mini-forceps to obtain tissue for diagnosis of enlarged mediastinal LAD is a safe and feasible technique, which provided a diagnosis in 86% of cases [ 19 ]. Recently, Mehta et al showed promising results in a small cohort of 30 patients using the 1.5 mm mini-forceps from Olympus [ 20 ]. The aim of the present study was to investigate the DY, safety, and feasibility of EBUS-TBFB using the 1.5 mm mini-forceps in addition to EBUS-TBNA as compared to standard EBUS-TBNA as a standalone technique for diagnosis of mediastinal/hilar LAD or masses in a bicentric study with a large cohort.…”

Rapid on‐site evaluation (ROSE) during endobronchial ultrasound bronchoscopy (EBUS) in the diagnosis of granulomatous diseases

“…Mehta et al described a novel transbronchial forceps biopsy (TBFB) approach for mediastinal lymphadenopathy sampling in their research. They suggested that BML such as sarcoidosis and TB, which are difficult to diagnose, should primarily be performed with ROSE accompanied EBUS; and recommended an algorithm that requires performing TBFB before surgery for cases with negative results 30 …”

Endobronchial ultrasound‐guided transbronchial cryo‐nodal biopsy: a novel approach for mediastinal lymph node sampling

“…Later, Herth et al applied this technique via EBUS guidance using 19‐gauge needles to create a tract for mini‐forceps and the yield was 88% [9]. Subsequently, many studies have demonstrated a yield of 91–97% via IFB without any increase in time or any significant adverse events [10–12].…”