title: Evaluation of a novel endobronchial ultrasound-guided lymph node forceps in enlarged mediastinal lymph nodes.
abstract: BACKGROUND
  Endobronchial ultrasound-transbronchial nee dle aspiration (EBUS-TBNA) is a useful technique for cytological assessment of enlarged mediastinal lymph nodes with a high diagnostic yield for lung cancer. However, the small sample volume can be problematic in diagnosing benign diseases and for molecular analysis of malignant tumours.
  
  
  OBJECTIVE
  The aim of the study was to evaluate a novel lymph node forceps for EBUS-guided lymph node biopsy (EBUS-transbronchial forceps biopsy; EBUS-TBFB) in malignant and benign conditions concerning safety, feasibility, and diagnostic yield.
  
  
  METHODS
  Patients with enlarged mediastinal or hilar lymph nodes were included. EBUS-TBNA was performed followed by EBUS-guided TBFB with the lymph node forceps. Three biopsy specimens were obtained. The diagnostic yields of EBUS-TBFB, EBUS-TBNA, and the combination of both sampling techniques were compared. Complications were systematically recorded.
  
  
  RESULTS
  Fifty-five patients with enlarged mediastinal nodes were enrolled into this study. Specimens adequate for histological analysis were obtained in all but one case using EBUS-TBFB. EBUS-TBFB increased the diagnostic yield of EBUS-TBNA from 64 to 93% in benign conditions. The overall diagnostic yield was higher compared to EBUS-TBNA alone. EGFR mutation analysis could be achieved in the forceps biopsy samples as needed. No complications were observed.
  
  
  CONCLUSIONS
  EBUS-TBFB with a novel lymph node forceps is safe and provides adequate histological specimens of enlarged mediastinal lymph nodes. EBUS-TBFB increases the diagnostic yield in benign conditions and may add value in molecular analysis of non-small cell lung cancer.
authors.affiliation: Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Kaid
authors.initials: K
authors.lastname: Darwiche
authors.forename: Lutz
authors.initials: L
authors.lastname: Freitag
authors.forename: Arun
authors.initials: A
authors.lastname: Nair
authors.forename: Christiane
authors.initials: C
authors.lastname: Neumann
authors.forename: Ruediger
authors.initials: R
authors.lastname: Karpf-Wissel
authors.forename: Stefan
authors.initials: S
authors.lastname: Welter
authors.forename: Jeremias
authors.initials: J
authors.lastname: Wohlschlaeger
authors.forename: Dirk
authors.initials: D
authors.lastname: Theegarten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000295:instrumentation*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult