title: Endobronchial ultrasound-guided miniforceps biopsy in the biopsy of subcarinal masses in patients with low likelihood of non-small cell lung cancer.
abstract: BACKGROUND
  Transbronchial needle aspiration (TBNA) is used to sample mediastinal masses, but the value may be limited by the small specimen size obtained. In benign diseases and hematologic malignancies, the sample size from TBNA is often considered insufficient for diagnosis. We evaluated the safety and efficacy of obtaining histologic specimens from subcarinal masses using a 1.15-mm miniforceps under endobronchial ultrasound (EBUS) guidance and compared the diagnostic yield with TBNA alone.
  
  
  METHODS
  Patients being evaluated for subcarinal lesions exceeding 2.5 cm (short axis) and without known or suspected non-small cell lung cancer were included. Bronchoscopy was performed, and EBUS-guided BNA of the lesion was performed first with a 22-gauge needle, followed by the 19-gauge needle. The miniforceps was then passed through the airway into the lesion (three to five passes) under real-time EBUS guidance. Three biopsy specimens were obtained.
  
  
  RESULTS
  The study enrolled 75 patients (41 men; mean age, 51.5 years). Specimens were acquired from each patient using the three techniques and processed separately. A specific diagnosis was made in 36% of patients with the 22-gauge needle, 49% with the 19-gauge needle, and in 88% with the miniforceps. The increase in diagnostic yield with miniforceps was most significant in patients with sarcoidosis (88% vs 36% for TBNA, p = 0.001) or lymphoma (81% vs 35%, p = 0.038). No complications occurred.
  
  
  CONCLUSIONS
  Miniforceps biopsy, performed under real-time EBUS guidance, can be used to obtain tissue specimens from subcarinal masses adjacent to the airway. The diagnostic yield for lymphoma and sarcoidosis is superior to TBNA alone, and the procedure appears safe.
authors.affiliation: Department of Pneumology and Critical Care Medicine, Thoraxklinik at University Heidelberg, Germany.
authors.forename: Felix J F
authors.initials: FJ
authors.lastname: Herth
authors.forename: Ross K
authors.initials: RK
authors.lastname: Morgan
authors.forename: Ralf
authors.initials: R
authors.lastname: Eberhardt
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation*; D020680:Bronchoscopes; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D019160:Endosonography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D017565:Sarcoidosis, Pulmonary / Q000000981:diagnostic imaging / Q000473:pathology; D013525:Surgical Instruments; D013945:Thymoma / Q000000981:diagnostic imaging / Q000473:pathology; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology