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

Abstract

When evaluating mediastinal/hilar lymphadenopathy (LAD) or masses, guidelines recommend endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) as an initial technique for tissue analysis and diagnosis. However, owing to the small sample size obtained by needle aspiration, its diagnostic yield (DY) is limited. EBUS transbronchial forceps biopsy (TBFB) used as a complimentary technique to EBUS-TBNA might allow for better histopathological evaluation, thus improving DY. In this retrospective bicentric study, we assessed the DY and safety of an EBUS-guided 1.5 mm mini-forceps biopsy combined with EBUS-TBNA for the diagnosis of mediastinal/hilar LAD or masses compared to EBUS-TBNA alone. In total, 105 patients were enrolled. The overall DY was 61.9% and 85.7% for TBNA alone and EBUS-TBNA combined with EBUS-TBFB, respectively (p < 0.001). While the combined approach was associated with a significantly higher DY for lung cancer diagnosis (97.1% vs. 76.5%, p = 0.016) and sarcoidosis (85.2% vs. 44.4%, p = 0.001), no significant differences in DY were calculated for subgroups with smaller sample sizes such as lymphoma. No major adverse events were observed. Using a 1.5 mm mini-forceps is a safe and feasible technique for biopsy of mediastinal or hilar LAD or masses with superior overall DY compared to EBUS-TBNA as a standalone technique.

Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study

“…There were no reported complications using the LN-TBFB method in the present study. Our results were in accordance with Rüber et al [ 16 ] who stated that the overall diagnostic yield was 61.9% and 85.7% for TBNA alone and EBUS-TBNA combined with EBUS-TBFB, respectively ( p < 0.001). The combined approach in their study was associated with a significantly higher diagnostic yield for lung cancer diagnosis (97.1% vs. 76.5%, p = 0.016) and sarcoidosis (85.2% vs. 44.4%, p = 0.001) and no major adverse events were observed.…”

“…There were attempts at obtaining forceps samples from mediastinal LNs by other investigators. Rüber et al [ 16 ] compared the safety, and yield of EBUS-TBFB using the 1.5 mm mini-forceps versus EBUS-TBNA alone. The overall DY was 61.9% and 85.7% for TBNA alone and EBUS-TBNA combined with EBUS-TBFB.…”

Transbronchial Lymph Node Forceps Biopsy as a Novel Tool in Diagnosis of Mediastinal Lymphadenopathy

“…There was no reported complication using LN-TBFB method in the present study. Our results were supported by Rüber et al (19) who stated that the overall diagnostic yield was 61.9% and 85.7% for TBNA alone and EBUS-TBNA combined with EBUS-TBFB, respectively (p < 0.001). The combined approach in their study was associated with a signi cantly higher diagnostic yield for lung cancer diagnosis (97.1% vs. 76.5%, p = 0.016) and sarcoidosis (85.2% vs. 44.4%, p = 0.001) and no major adverse events were observed.…”

“…For the comorbidities, 5.6% of them had chronic peptic ulcer, 16.7% had ischemic heart disease and diabetes mellitus, 22.2% had arterial hypertension and 11.1% had vocal cord paralysis. The current study was supported by Rüber et al (19) , who investigated the 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 lymphadenopathy. Their study included 64.8% males with a mean age of 63.1 years (± 13.6) and 58% were current or former smokers.…”

“…Also, there were lung nodules in 61.1%, GGO (ground glass opaci cation) in 38.9%, reticulation in 33.3%, lung mass, pleural effusion & pericardial effusion in 5.6% each. However, Rüber et al (19) stated that the most common affected lymph nodes stations included subcarinal lymph nodes (group 7) (48/107), 11R (24/107), 11L (21/107) and 4R (7/107). Also, Darwiche et al (18) mentioned that the most common station was the sub-carina (station 7) or right hilar (station 10R) region.…”