Improved Efficacy of Endobronchial Ultrasound-Guided Fine-Needle Aspiration Biopsy in Comparison to Endobronchial Ultrasound-Guided Miniforceps Biopsy

Abstract

Objective: Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) cytology and EBUS-miniforceps biopsy (MFB) have emerged as less invasive tools for evaluating mediastinal lymph nodes and pulmonary lesions. The aim of this study is to compare the diagnostic yields of EBUS-FNA cytology to EBUS-MFB. Study Design: A retrospective cohort study was performed by reviewing the database at our institution between December 12, 2010, and August 10, 2012. A total of 476 consecutive cases were identified. Of these, 227 patients had concurrent FNA and MFB taken during the procedure. The results and diagnostic yields of both techniques are calculated. Results: Of the 476 cases, the mean age was 62 ± 14 years with 53% being males. In 453 of the total cases, the less invasive FNA technique alone produced enough diagnostic cytology material negating the need for concurrent MFB. Of these FNA cases, 280 were diagnosed as malignant neoplasms. The diagnostic yield of EBUS-FNA cytology was comparable to EBUS-MFB (95% FNA and 94% MFB). There were discordant diagnoses between cytology and histology in 19 of the 227 (∼8.4%) cases. Conclusions: EBUS-FNA cytology is a more efficacious diagnostic modality compared to EBUS-MFB.

Standardized terminology and nomenclature for respiratory cytology: The Papanicolaou Society of Cytopathology guidelines

“…Techniques to obtain cytologic material include induced sputum, bronchial brushings, bronchial washings, percutaneous fine‐needle aspiration (FNA), conventional transbronchial FNA, and endobronchial ultrasound guided FNA . Each technique has characteristic sensitivities and specificities with recent studies suggesting that image guided FNA has the best diagnostic accuracy . Given the importance of these sampling techniques, it is clear that cytopathologists play a central role in the diagnostic evaluation of pulmonary nodules and masses.…”

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

“…Herth et al [21] also suggested that the use of a 1.15-mm miniforceps increased the diagnostic yield in patients with sarcoidosis (from 36 to 88%) or lymphoma (from 35 to 81%) in a series of 75 patients not suspected of having lung cancer, and, in a noncontrolled case series, the use of a bevel-tip needle forceps was studied [22]. Finally, a recent retrospective study performed by Wang et al [26] comparing conventional EBUS-TBNA to EBUS-MFB in a population with 59% malignant disease showed that diagnostic yield was equal in both groups (94 vs. 95%, respectively). Furthermore, they found that EBUS-TBNA rendered enough material for a diagnosis in 453/476 cases, thus negating the need for the additional MFB biopsy [26].…”

“…Finally, a recent retrospective study performed by Wang et al [26] comparing conventional EBUS-TBNA to EBUS-MFB in a population with 59% malignant disease showed that diagnostic yield was equal in both groups (94 vs. 95%, respectively). Furthermore, they found that EBUS-TBNA rendered enough material for a diagnosis in 453/476 cases, thus negating the need for the additional MFB biopsy [26]. In conclusion, the use of a miniforceps does not seem to influence the diagnostic yield in lung cancer but may be useful in patients with a suspected lymphoma or sarcoidosis.…”

Malignancy risk for the categories: Non‐diagnostic, benign, atypical, suspicious, and malignant used in the categorization of endobronchial ultrasound guided‐fine needle aspirates of pulmonary nodules

“…Despite adequate published data on the sensitivity and a specificity of EBUS‐FNA for pulmonary lesions, little data exists as to the malignancy risk associated with commonly utilized diagnostic categories. While no widely accepted diagnostic categorization for pulmonary cytology specimens currently exists, many cytopathologists use a categorization system similar to that published by the Papanicolaou Society of Cytopathology (P.S.C.)…”