The contribution of endobronchial ultrasound-guided forceps biopsy in the diagnostic workup of unexplained mediastinal and hilar lymphadenopathy.
BACKGROUND
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) provides material for the cytological diagnostic workup. To improve the evaluation of unexplained intrathoracic lymphadenopathy, the availability of material for histological evaluation would be desirable. For this purpose, the technique of endobronchial ultrasound-guided mediastinal forceps biopsy (EBUS-guided forceps biopsy) is a potentially good candidate. The aim of the present study was, using simple methodology, to establish the additional diagnostic yield provided by supplemental EBUS-guided forceps biopsy in comparison with EBUS-TBNA alone.


METHODS
The data of 50 consecutive patients with mediastinal, lobar, and hilar space-consuming lesions were analyzed. In all patients, immediately following EBUS-TBNA with a 22-gauge needle, a 21-gauge forceps was introduced through the opening created in the bronchial wall and an EBUS-guided forceps biopsy performed. The improvement in the diagnostic yield was determined. The diagnostic yield of the EBUS-guided forceps biopsy in relation to the size of the biopsy specimen and that of the EBUS-TBNA in relation to the cell-block technique were determined.


RESULTS
Combining the techniques increased the diagnostic sensitivity of the EBUS-TBNA from 50.0 to 82.0%. EBUS-guided forceps biopsies measuring ≥ 3 mm enabled a specific diagnosis to be established more often than did forceps biopsies <3 mm (90.9% vs. 57.1%). A cell block was prepared in 29 patients. In this case, EBUS-TBNA provided a higher diagnostic yield (65.5% vs. 28.6%) compared to cytology alone.


CONCLUSIONS
EBUS-guided forceps biopsy should be employed for the bronchoscopic diagnosis of intrathoracic lymphadenopathy of unknown etiology.
Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, Witten/Herdecke University, Ambrocker Weg 60, 58091 Hagen, Germany. karl-josef.franke@helios-kliniken.de
Karl-Josef
KJ
Franke
Christiane
C
Bruckner
Mara
M
Szyrach
Karl-Heinz
KH
Ruhle
Georg
G
Nilius
Dirk
D
Theegarten
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001999:Bronchoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000009:adverse effects