Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard diagnostic method for sampling mediastinal and hilar lymph nodes. Non-diagnostic samples have led some pulmonologists to add a miniforceps biopsy (EBUS-TBFB) in order to increase diagnostic yield. Our study aims to analyze the impact of adding EBUS-TBFB to the EBUS-TBNA in cases where Rapid On-site Evaluation (ROSE) was negative for malignancy or was non-diagnostic. This retrospective chart review included 91 patients who were aged 18-90 years old and underwent EBUS with both TBNA and TBFB between January 1, 2013 and July 1, 2018. There was no significant statistical difference in the diagnostic yield of TBNA vs TBFB with a McNemar value of 0.167, and this conclusion was the same when stratified by race, age and lymph node size. Using TBNA as a gold standard, the sensitivity and specificity of TBFB was 87% and 69%, respectively. Out of the non-diagnostic TBNA samples on ROSE and cell-block, subsequent TBFB resulted in additional pathologic diagnoses in 16% of cases, of which 67% were non-caseating granulomas. Furthermore, two additional malignant cases were identified by TBFB consisting of small cell carcinoma and non-Hodgkin's lymphoma. In conclusion, TBFB is a useful adjunctive tool in the diagnosis of non-malignant conditions (i.e. granulomatous diseases) with the potential to spare the patient from more invasive surgical biopsies. Training of future fellows in performing TBFB in addition to TBNA should be strongly encouraged.
Highlights
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard diagnostic method for sampling mediastinal and hilar lymph nodes
Our study aimed to analyze the impact of adding EBUS-TBFB to the EBUS-TBNA in cases where Rapid On-site Evaluation (ROSE) was deemed negative for malignancy or was non-diagnostic
After obtaining an EBUS-TBNA sample which was found to be non-diagnostic on initial ROSE, the sampled lymph node was evaluated by EBUS-TBFB
Summary
Since its introduction in 1983 [1, 2], transbronchial needle aspiration (TBNA) has been a minimally invasive procedure for the sampling of mediastinal lymph nodes using bronchoscopy. In 2002, with the introduction of the convex probe endobronchial ultrasound (CP-EBUS), clinicians were able to perform real-time endobronchial visualization for TBNA. Sample acquisition is performed through the initial hole made by the TBNA needle for obtaining diagnostic material from enlarged lymph nodes [6, 10,11,12]. Recent studies using TBFB for lymphadenopathy have shown improved yields; these studies have had their limitations that included lack of EBUS guidance, use of initial TBNA puncture site prior to performing TBFB, and/or Rapid On-site Evaluation (ROSE). Our study aimed to analyze the impact of adding EBUS-TBFB to the EBUS-TBNA in cases where ROSE was deemed negative for malignancy or was non-diagnostic
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