EBUS guided Transbronchial needle biopsy (EBUS TBNB) of subcarinal lymph nodes – a Pilot study

Abstract

In cases of hard rubbery lymph nodes like in Sarcoidosis and Lymphoma, it is sometimes difficult to obtain optimum cytology samples during EBUS TBNA (Transbronchial needle aspiration cytology) and thus the diagnostic yield of EBUS TBNA samples drops down to 60%. An EBUS TBNB sample from such lymph nodes can help to increase the diagnostic yield.

Methods: We did a Pilot study in patients presenting with hard rubbery lymph nodes during EBUS TBNA, EBUS guided Transbronchial biopsy of the subcarinal lymph node was done with small size biopsy forceps. Diagnostic yield of biopsy samples was compared with EBUS TBNA cytology results.

Results: Over a period of 6 months, 11 patients underwent EBUS guided transbronchial biopsy of Subcarinal lymph node. 9 patients were male and the average age was 46 years (Range 19 to 65 years). EBUS guided TBNB sample could be successfully obtained in 9 patients. In 2 patients (final diagnosis was Sarcoidosis and Lung cancer respectively), biopsy needle failed to pierce the subcarinal lymph node. TBNB samples provided the diagnosis in all 9 patients (Sarcoidosis in 3 patients, Tuberculosis in 4 patients, Lung cancer in 1 patients and Acute myeloid leukaemia in one patient). But in all these 9 patient EBUS TBNA samples were also diagnostic of the same pathology.

EBUS TBNB did not increase the diagnostic yield of EBUS guided procedure in this pilot study with only 11 patients. However, the study proves that it is feasible to do EBUS TBNB. It is a promising new technique and may help in increasing the diagnostic yield in a prospective trial with a large number of patients, especially when Pulmonologist finds it hard to obtain an adequate cytology sample with EBUS TBNA.