The diagnostic efficacy of combining bronchoscopic tissue biopsy and endobronchial ultrasound‐guided transbronchial needle aspiration for the diagnosis of malignant lesions in the lung

Abstract

Bronchoscopic tissue forceps biopsy (BBX) is a standard procedure for diagnosis of malignancy in the lung. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has proven to be a sensitive alternative to tissue biopsy for the diagnosis and staging of lung tumors. We report our institutional experience with diagnostic yield when combining BBX and EBUS-TBNA in the bronchoscopic evaluation of patients presenting with lung lesion(s). The pathology files at our institution were searched for all patients who underwent combined BBX and EBUS-TBNA procedures between 1/09 and 6/10 for the diagnosis of malignancy. The data points included biopsy site, cytologic, and histopathologic diagnoses and follow-up. We identified 115 patients who underwent BBX combined with EBUS-TBNA. About 107 (93%) of the patients received a definitive pathologic diagnosis; 93 (81%) were malignant. BBX and EBUS-TBNA of the lung lesion only were performed in 21 patients, BBX and EBUS-TBNA of lymph node(s) only in 78 patients with BBX and a combination of EBUS-TBNA of the lung lesion and lymph node(s) in 16 patients. Immunostains were performed for 71 (76%) patients and molecular testing for 11 (12%) patients. Diagnostic yield is increased when bronchoscopic technologies are combined. In a significant number of patients where BBX was negative, EBUS-TBNA provided diagnostic material, increasing diagnostic yield by 18%. In a subset of these patients the EBUS-TBNA assisted in the staging of a primary tumor. By combining these procedures, more tissue was obtained for immunohistochemistry and molecular testing, which facilitated personalized management in a minimally invasive manner.

Convex probe EBUS for centrally located parenchymal lesions without a bronchus sign

“…Other investigators have commented on the use of combining conventional techniques with CP-EBUS to increase diagnostic yield. Schwartz et al [15] described 115 patients who underwent tissue forceps biopsies combined with EBUS-TBNA, either of lymph nodes or central lesions. Of these, 21 (18%) underwent biopsy of the lung lesion using forceps and EBUS-TBNA without nodal sampling.…”

A Case of Hodgkin's Lymphoma Diagnosed by Endobronchial Ultrasound-Guided Transbronchial Forceps Biopsies

“…EBUS-TBNA was especially valuable when BBX results were negative, increasing diagnostic yield by 18% and assisting in tumor staging. Additionally, the combination allowed for more tissue sampling for immunohistochemistry and molecular testing, facilitating personalized management in a minimally invasive manner [ 1 ].…”

“…Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a widely used procedure and has been validated for the diagnosis and staging of lung cancer and the diagnosis of sarcoidosis. Despite its established role in lung cancer staging, its diagnostic accuracy in lymphoma remains a subject of debate due to certain disadvantages, such as lesser core tissue sampling and inferior negative predictive value [ 1 ]. This article highlights the importance of EBUS-guided transbronchial forceps biopsy (TBFB) in lymphoma diagnosis and discusses its role as a valuable adjunct to EBUS-TBNA in improving diagnostic accuracy.…”

Transbronchial needle aspiration cytology of endobronchial abnormalities: does it increase the positivity rates of bronchoscopy

“…9 The use of conventional TBNA and that of Endobronchial ultrasound (EBUS) -TBNA in staging of lung cancer and diagnosis of mediastinal masses is however well accepted. [10][11][12][13] The utility of EBUS-TBNA to diagnose paren-chymal lesions in cases of non-diagnostic conventional bron-choscopy is being recognized and emerging. Several studies have been conducted to evaluate the usefulness of EBUS-TBNA for detecting malignancy in the parenchymal lesions locat¬ed adjacent to the central airways.…”