Diagnostic Yield of Endobronchial Ultrasound–Guided Mediastinal Lymph Node Transbronchial Forceps Biopsies (EBUS-TBFB). Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Diab, Khalil; Costanian, Christy; Bikak, Marvi; Al Nasrallah, Nawar; Al-Hader, Ahmad A.; Bendaly, Edmond; Zhang, Chen; Assi, Rita
• Is Part Of: Southern medical journal. Volume 116:Issue 2(2023)
• Page Start: 202
• Page End: 207
• Publication Date: 2023-02
• Subjects: endobronchial ultrasound -- interventional pulmonology -- lymphoma -- mediastinal adenopathy; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001509
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Endobronchial ultrasound–guided transbronchial needle aspiration has become the gold standard for the staging of lung cancer, and is being used for the diagnosis of other mediastinal-related diseases. Its utility in subtyping lymphoma and obtaining a full genomic profile in lung cancer has been limited. The authors review the role of endobronchial ultrasound–guided transbronchial forceps biopsies, in addition to needle aspiration, in the diagnosis of lymphoma, sarcoidosis, and lung cancer. Abstract : Objective: The diagnostic accuracy and yield of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is not well established in lymphoma and other mediastinal-related diseases. The objective of this study was to examine the yield of a combined technique of EBUS-TBNA and endobronchial ultrasound–guided transbronchial forceps biopsies (EBUS-TBFB) compared with each modality alone in lymphoma and other mediastinal-related diseases. Methods: This was a retrospective review of cases of mediastinal lymphadenopathy of unknown etiology accessed using TBNA and TBFB. The McNemar test was used to compare the diagnostic yield of TBNA, TBFB, and the combined technique. Results: The combined approach yielded a definitive diagnosis in 31/35 cases (88.6%). In 9/10 cases (90%), Hodgkin's and non-Hodgkin's lymphomas were diagnosed and subtyped without further need for invasive testing. All of the granulomatous inflammation cases were confirmed using the combined technique. Two cases led to adequate whole-genome sequencing of lung cancer, and one patient was diagnosed as having dedifferentiated liposarcoma despite a nondiagnostic preprocedural mediastinoscopy. There was only one procedure-related complication, a pneumomediastinum that required no further intervention. There were no significant adverse events. Conclusions: The combination of EBUS-TBFB and EBUS-TBNA is safe and provides a high yield in the diagnosis of mediastinal adenopathy of unknown etiology, especially lymphoma. Furthermore, the larger samples obtained from TBFB increased its sensitivity to detect granulomatous disease and provided specimens for clinical trials of malignancy when needle aspirates were insufficient.