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A5019 - Role of Endobronchial Ultrasound Guided Miniforceps Biopsy in Mediastinal Lesions
Author Block: M. Kondapaneni1, J. Bowen2; 1Pulmonary and Critical Care, SSM Good Samaritan Hospital, Mount Vernon, IL, United States, 2Respiratory Care, SSM Good Samaritan Hospital, Mount Vernon, IL, United States.
Introduction: Endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) is a minimally invasive technique for diagnostic evaluation of mediastinal lymphadenopathy. Literature suggest that in most cases TBNA is adequate for cytopathological and molecular testing. Miniforceps biopsy (MFB), using 1mm forceps, of lymph nodes under ultrasound guidance has previously been shown to have benefits but is not widely used. We hypothesized that MFB provides larger tissue sample and can improve diagnostic yield where TBNA could not provide clear information. Methods: We used previously reported techniques for obtaining MFB specimens under EBUS guidance. The procedure was conducted under general anesthesia. Briefly the target lymph node(s) were identified with EBUS and a regular TBNA was performed initially with 21G needle with real time ultrasound visualization. The entry points of the needle on the mucosa and the needle track on the ultrasound were saved. Using these as markers/guides the biopsy forceps was passed into the lymph node under direct visualization with EBUS. A pathologist performed rapid on-site evaluation (ROSE) of the obtained specimens. Results: Transbronchial forceps biopsy of lymph nodes was performed in three cases where despite large lymph nodes no specific on-site diagnosis could be confirmed on the needle biopsy. These cases involved a mediastinal cyst, lymphadenopathy due to black lung and an adenocarcinoma. ROSE revealed a larger biopsy sample from forceps compared to needle biopsy. We selectively performed this procedure in patients who have large lymph nodes (~2cm) in stations either 4R or 7 only. All the passes were carefully observed under EBUS. Two to three passes were performed in each node. The forceps was seen sliding between the mucosa and lymph node instead of going in the needle track in one of the passes. Forceps malfunctioned in one of the cases in the endobronchial lumen. However, there were no complications that are directly related to using miniforceps or needle in these patients. Discussion: EBUS-MFB of lymph nodes appears to be a safe technique that provides much larger tissue sample compared to needle biopsies. Procedurally it is only slightly more challenging than a regular EBUS-TBNA. While it appears to be a safe technique, additional care is warranted based on our experience. Further studies are needed to establish the role of EBUS-MFB in sampling of mediastinal lymph nodes. These studies should address the safety, selection of patients, advantages and disadvantages of EBUS guided MFB vs TBNA.