Endobronchial Ultrasound-Guided Miniforceps Biopsy in the Biopsy of Subcarinal Masses in Patients with Low Likelihood of Non-Small Cell Lung Cancer

doi:10.1016/j.athoracsur.2008.02.031

The Annals of Thoracic Surgery

Volume 85, Issue 6, June 2008, Pages 1874-1878

https://doi.org/10.1016/j.athoracsur.2008.02.031 Get rights and content

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.

Section snippets

Material and Methods

From January 2006 to January 2007, consecutive patients referred for bronchoscopy and with subcarinal masses greater than 25 mm in the short axis on chest computed tomography were enrolled prospectively in the study. Patients with known or suspected non-small cell lung cancer undergoing mediastinal staging for this disease were not included because we and others have previously shown that EBUS-guided TBNA has excellent diagnostic yield in this population [7]. The study was approved by the

Results

These sequential techniques were performed at bronchoscopy in 74 patients (41 men) with a median age of 53 years (range, 27 to 71 years). The specimens obtained were suitable for analysis in all cases. A final diagnosis was available for all patients at follow-up and allowed calculation of the diagnostic yield for each technique of lymph node sampling (Table 1). The mean size of the masses sampled was 3.27 cm (range, 2.5 to 4.2 cm), and no significant correlation was seen between the size of

Comment

Chest physicians are commonly involved in the assessment of patients with mediastinal lymphadenopathy. In the past these patients were commonly referred directly for a surgical biopsy through a mediastinoscopy. The advent of endoscopic and EBUS guidance in the last few years, which increase the yield from TBNA [5, 6, 7], as well as a recognition that in practice mediastinoscopy may not be used as well as it could [11], interest has been growing in noninvasive sampling of mediastinal lymph

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Cited by (89)

Comparison of cryobiopsy and forceps biopsy for the diagnosis of mediastinal lesions: A randomised clinical trial
2024, Pulmonology
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard approach for lung cancer staging. However, its diagnostic utility for other mediastinal diseases might be hampered by the limited tissue retrieved. Recent evidence suggests the novel sampling strategies of forceps biopsy and cryobiopsy as auxiliary techniques to EBUS-TBNA, considering their capacity for larger diagnostic samples.
This study determined the added value of forceps biopsy and cryobiopsy for the diagnosis of mediastinal diseases. Consecutive patients with mediastinal lesions of 1 cm or more in the short axis were enrolled. Following completion of needle aspiration, three forceps biopsies and one cryobiopsy were performed in a randomised pattern. Primary endpoints included diagnostic yield defined as the percentage of patients for whom mediastinal biopsy led to a definite diagnosis, and procedure-related complications.
In total, 155 patients were recruited and randomly assigned. Supplementing EBUS-TBNA with either forceps biopsy or cryobiopsy increased diagnostic yield, with no significant difference between EBUS-TBNA plus forceps biopsy and EBUS-TBNA plus cryobiopsy (85.7 % versus 91.6 %, P = 0.106). Yet, samples obtained by additional cryobiopsies were more qualified for lung cancer molecular testing than those from forceps biopsies (100.0 % versus 89.5 %, P = 0.036). When compared directly, the overall diagnostic yield of cryobiopsy was superior to forceps biopsy (85.7 % versus 70.8 %, P = 0.001). Cryobiopsies produced greater samples in shorter procedural time than forceps biopsies. Two (1.3 %) cases of postprocedural pneumothorax were detected.
Transbronchial mediastinal cryobiopsy might be a promising complementary tool to supplement traditional needle biopsy for increased diagnostic yield and tissue harvesting.
ChiCTR2000030373
Endobronchial ultrasound bronchoscopy Franseen fine needle biopsy tool versus standard fine needle aspiration needle: Impact on diagnosis and tissue adequacy
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The Franseen fine needle biopsy tool (Acquire®, Boston Scientific, Boston, MA) may provide better quality specimens than current endobronchial ultrasound-transbronchial needle aspiration (EBUS-TNBA) needles. We performed a comparative retrospective study evaluating the diagnostic yield of the Franseen fine needle biopsy (FNB) versus standard fine needle aspiration (FNA) for benign lymphadenopathy and tissue acquisition for next generation sequencing (NGS) in non-small cell carcinoma (NSCLC).
All EBUS-TBNA procedures performed between January 1st, 2019 to January 1st^, 2020 where both the FNB needle and the FNA needle were used were analyzed. All demographic, procedural, and diagnostic data were recorded. The median tumor surface area, tumor cellularity and adequacy for NGS was evaluated for NSCLC specimens.
A total of 69 target lesions in 66 patients were biopsied with both the FNB and FNA needles. The mean (SD) size of target biopsied was 1.8 cm (0.8); The most common stations were 7 (54%) and 4R (26%). The mean (SD) needle passes were 6 (2.2) and 4 (1.8) with FNA and FNB needles, respectively (p < 0.0001). Benign lymphadenopathy was diagnosed with FNA needle in 46% and in 82% with FNB (p < 0.0001). NGS tissue adequacy was 47% with FNA needle versus 76% with FNB (p = 0.02). Median tumor surface area and tumor cellularity were greater with FNB needle than FNA needle (80 mm² versus 9 mm², p = 0.002, and 81% versus 45%, p = 0.0004).
The FNB needle demonstrated higher diagnostic yield in benign lymphadenopathy and higher quality for NGS than standard FNA needle.
Combined EBUS-IFB and EBUS-TBNA vs EBUS-TBNA Alone for Intrathoracic Adenopathy: A Meta-Analysis
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Citation Excerpt :
The funnel plot scatter does not indicate any obvious publication bias (Figure 2B). Secondary subgroup analysis of 6 studies15,19-23 for sarcoidosis revealed a diagnostic yield of 58% (93 of 161) for EBUS-TBNA and 93% (150 of 161) for the combined EBUS-TBNA and EBUS-IFB group, with an inverse variance-weighted OR of 12.26 (95% CI, 5.96 to 25.22; P < .00001) and an I2 of 0%. The funnel plot scatter does not indicate any obvious publication bias (Supplemental Figure 2).
Endobronchial ultrasound (EBUS)–guided intranodal forceps biopsy (IFB) is considered complementary to EBUS-guided transbronchial needle aspiration (TBNA) (EBUS-TBNA) for patients with intrathoracic lymphadenopathy either when additional tissue is requested for comprehensive molecular testing or for suspected lymphoma and sarcoidosis. This systematic review and meta-analysis investigated the diagnostic yield and complications of combined EBUS-IFB and EBUS-TBNA compared with EBUS-TBNA alone.
A systematic search was performed of Medline, Embase, and Google Scholar for studies evaluating the use of EBUS-IFB for diagnosis of intrathoracic adenopathy, and the quality of each study was assessed using the Quality Assessment, Data abstraction and Synthesis-2 tool. Using inverse variance weighting, a meta-analysis of diagnostic yield estimations was performed. The complications related to the procedure were also reviewed.
Six observational studies with 443 patients undergoing 467 biopsies were included in the final analysis. Meta-analysis yielded a pooled overall diagnostic yield of 67% (312 of 467) for EBUS-TBNA and 92% (428 of 467) for EBUS-TBNA in combination with EBUS-IFB, with an inverse variance-weighted odds ratio of 5.87 (95% confidence interval, 3081 to 9.04; P < .00001) and an I² of 15%. The overall complications included pneumomediastinum (1%), bleeding (0.8%), and respiratory failure (0.6%). The funnel plot analysis illustrated no major publication bias. Subgroup analysis showed increased diagnostic yield for lymphoma (86% vs 30%; P = .03) and sarcoidosis (93% vs 58%; P < .00001).
The addition of EBUS-IFB to EBUS-TBNA improves the overall diagnostic yield of sampling intrathoracic adenopathy when compared with EBUS-TBNA alone. The complication rates of the combined approach are higher than with EBUS-TBNA, but they are reportedly lower than with transbronchial or surgical biopsies.
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Original articleGeneral thoracicEndobronchial Ultrasound-Guided Miniforceps Biopsy in the Biopsy of Subcarinal Masses in Patients with Low Likelihood of Non-Small Cell Lung Cancer

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Chest

Chest

Chest

Chest

Ann Thorac Surg

Am J Gastroenterol

Chest

Chest

Gastrointest Endosc

J Thorac Cardiovasc Surg

Flexible transbronchial needle aspiration for staging of bronchogenic carcinoma

Chest

Original article
General thoracic
Endobronchial Ultrasound-Guided Miniforceps Biopsy in the Biopsy of Subcarinal Masses in Patients with Low Likelihood of Non-Small Cell Lung Cancer