title: Endobronchial-ultrasound guided miniforceps biopsy of mediastinal and hilar lesions.
abstract: BACKGROUND
  Linear array endobronchial ultrasound (EBUS) has greatly improved the diagnostic yield of transbronchial needle aspiration (TBNA) for the diagnosis of non-small cell lung carcinoma though its yield in granulomatous disease and lymphoproliferative disorders is less robust. The EBUS-miniforceps biopsy (MFB) uses miniforceps and the convex probe EBUS bronchoscope to obtain forceps biopsies of centrally located lesions under continuous ultrasound guidance. In this prospective study we evaluate the efficacy of this technique for diagnosing mediastinal and hilar abnormalities in patients with a low suspicion for non-small cell lung carcinoma.
  
  
  METHODS
  Patients presenting with mediastinal or hilar lymphadenopathy and a low likelihood of non-small cell lung carcinoma underwent EBUS-TBNA and EBUS-MFB of mediastinal and hilar abnormalities. The diagnostic yield EBUS-TBNA and EBUS-MFB was compared as was the combined yield of both techniques versus either technique alone.
  
  
  RESULTS
  Between June 2008 and July 2010, 50 patients underwent EBUS-TBNA and EBUS-MFB of 74 lymph node stations. The overall diagnostic yield of EBUS-TBNA and EBUS-MFB was 81% (60 of 74) and 91% (67 of 74), respectively (p=0.09). When the 2 techniques were combined, the overall diagnostic yield was 97% (72 of 74) (p<0.001), which was significant when compared with EBUS-TBNA alone. No complications were observed as a result of EBUS-MFB, and EBUS-MFB did not appear to significantly prolong the procedure.
  
  
  CONCLUSIONS
  The EBUS-miniforceps biopsy is an effective, safe, and efficient method of obtaining histopathologic specimens from mediastinal and hilar abnormalities in patients with a low likelihood of non-small cell lung carcinoma, particularly when the technique is combined with EBUS-TBNA.
authors: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA.
authors: Ara
authors: A
authors: Chrissian
authors: David
authors: D
authors: Misselhorn
authors: Alexander
authors: A
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000295:instrumentation* / Q000379:methods; D001999:Bronchoscopy / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D016001:Confidence Intervals; D019160:Endosonography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity