Multimodal linear endobronchial ultrasound guided mediastinal lymph node biopsy in the diagnosis of isolated mediastinal lymphadenopathy

Kho, Sze Shyang; Soo, Chun Ian; Nasaruddin, Mona Zaria; Ngan, Kah Wai; Rahaman, Jamalul Azizi Abdul

doi:10.1177/20101058221111655

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…This has led different investigators to study different techniques using EBUS to guide biopsy forceps and cryo-probes to perform biopsies of mediastinal lesions and lymph nodes in the hope of acquiring more adequate tissue for all needed pathologic and cytologic evaluations [20,21]. This review will summarize the utility of EBUS-guided intranodal forceps biopsies (EBUS-IFB) and transbronchial cryonodal biopsies (EBUS-TBCB) and compare those techniques to EBUS-TBNA.…”

Section: Introductionmentioning

confidence: 99%

A Review of Endobronchial-Ultrasound-Guided Transbronchial Intranodal Forceps Biopsy and Cryobiopsy

Chalhoub,

Joseph,

Acharya

2024

Diagnostics

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Benign and malignant mediastinal lesions are not infrequently encountered in clinical practice. Mediastinoscopy has long been considered the gold standard in evaluating mediastinal pathology. Since its introduction into clinical practice, endobronchial-ultrasonography-guided transbronchial fine needle aspiration (EBUS-TBNA) has replaced mediastinoscopy as the initial procedure of choice to evaluate mediastinal lesions and to stage lung cancer. Its diagnostic yield in benign mediastinal lesions and less common malignancies, however, has remained limited. This has led different proceduralists to investigate additional procedures to improve the diagnostic yield of EBUS-TBNA. In recent years, different published reports concluded that the addition of EBUS-guided intranodal forceps biopsy (IFB) and transbronchial cryobiopsy (TBCB) to EBUS-TBNA increases the diagnostic yield especially in benign mediastinal lesions and uncommon mediastinal malignancies. The purpose of this review is to describe how EBUS-IFB and EBUS-TBCB are performed, to compare their diagnostic yields, and to discuss their limitations and their potential complications. In addition, the review will conclude with a proposed algorithm on how to incorporate EBUS-IFB and EBUS-TBCB into clinical practice.

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Section: Introductionmentioning

confidence: 99%

A Review of Endobronchial-Ultrasound-Guided Transbronchial Intranodal Forceps Biopsy and Cryobiopsy

Chalhoub,

Joseph,

Acharya

2024

Diagnostics

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An explorative analysis on the optimal cryo-passes and freezing time of the ultrathin cryoprobe in endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy

Kho,

Tan,

Soo

et al. 2024

Sci Rep

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EBUS-guided transbronchial mediastinal cryobiopsy (TBMC) has emerged as a promising biopsy tool for diagnosing hilar and mediastinal pathologies. However, several fundamental technical aspects of TBMC remain unexplored. This study aims to determine the optimal number of cryo-passes and freezing time of the ultrathin cryoprobe in EBUS-TBMC concerning specimen size and procedural diagnostic yield. We conducted a retrospective chart review of patients with mediastinal and hilar lesions who underwent EBUS-TBMC between January 2021 and April 2023 across three hospitals in Malaysia. A total of 129 EBUS-TBMC procedures were successfully completed, achieving an overall diagnostic yield of 88.4%. Conclusive TBMC procedures were associated with larger specimen sizes (7.0 vs. 5.0 mm, p < 0.01). Specimen size demonstrated a positive correlation with diagnostic yield (p < 0.01), plateauing at specimen size of 4.1–6.0 mm. A significant positive correlation was also observed between the number of cryo-passes and both specimen size (p < 0.01) and diagnostic yield (p < 0.05). Diagnostic yield plateaued after 2–3 cryo-passes. In contrast, longer freezing times trended towards smaller specimens and lower diagnostic yield, though not reaching statistical significance. The highest diagnostic yield was recorded at the 3.1–4.0 s freezing time. The safety profile of TBMC remains favourable, with one case (0.8%) of pneumothorax and nine cases (7%) of self-limiting bleeding. In our cohort, TBMC performance with 2–3 cryo-passes and a 3.1–4.0 s freezing time to achieve a total aggregate specimen size of 4.1–6.0 mm appeared optimal. Further prospective studies are needed to validate these findings.

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Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: Insights and technical tips from our early experience with 30 patients

Soo

Kho

2023

Preprint

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BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to diagnose and stage lung cancer. In real-life practice, limitations are seen with cytology samples from EBUS-TBNA. Obtaining adequate samples can be challenging when faced with necrotic lesions with low cellular yield and the evolving landscape of targeted therapy, necessitating additional samples for comprehensive testing. Hence, transbronchial mediastinal cryobiopsy guided by endobronchial ultrasound (EBUS-TBMC) has emerged as a promising approach for obtaining larger tissue samples. In retrospective review, our aim is to present our early experience regarding the feasibility of performing EBUS-TBMC, employing a similar approach to EBUS-TBNA, followed by the outcomes of our procedures. We include a step-by-step explanation and some recommendations to conduct a successful EBUS-TBMC.MethodSingle center retrospective analysis to evaluate the feasibility and utility of EBUS-TBMC cases over six months from July to December 2022.Results36 EBUS-TBMC procedures on 30 patients. Moderate sedation was used in 80% of cases. Majority (83.4%) of the patients had biopsy of a single lesion with a median of 3 cryobiopsies (Interquartile range 3-4). The median cryo-activation time was 6 seconds (Interquartile range 6-8). EBUS-TBMC demonstrated a positive yield of 86.1% with an overall diagnostic yield of 83.3%. Mild bleeding occurred in six biopsies (16.7%) which did not required further intervention. No other major complications were observed.ConclusionEBUS-TBMC is a safe and effective alternative to EBUS-TBNA. Histology samples obtained through EBUS-TBMC have the potential to increase confidence in diagnosing and staging lung cancer, thereby alleviating concerns about tissue inadequacy.

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Multimodal linear endobronchial ultrasound guided mediastinal lymph node biopsy in the diagnosis of isolated mediastinal lymphadenopathy

Cited by 3 publications

References 10 publications

A Review of Endobronchial-Ultrasound-Guided Transbronchial Intranodal Forceps Biopsy and Cryobiopsy

A Review of Endobronchial-Ultrasound-Guided Transbronchial Intranodal Forceps Biopsy and Cryobiopsy

An explorative analysis on the optimal cryo-passes and freezing time of the ultrathin cryoprobe in endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy

Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: Insights and technical tips from our early experience with 30 patients

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