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A5015 - Safety and Effectiveness of Endobronchial Ultrasound (EBUS) Guided Intranodal Forcep Biopsies
Author Block: A. K. Mahajan1, D. Collins2, K. Webster3, H. Mani3, S. Khandhar2; 1Inova Fairfax Hospital, Falls Church, VA, United States, 2Thoracic Surgery, Inova Fairfax Hospital, Falls Church, VA, United States, 3Pathology, Inova Fairfax Hospital, Falls Church, VA, United States.
PURPOSE: Endobronchial ultrasound bronchoscopy (EBUS) is a minimally invasive procedure used to biopsy lymph nodes and central lung masses. This modality is effective in diagnosing both malignant and benign diseases of the chest. Traditionally, EBUS guided transbronchial needle aspiration (TBNA) has been utilized for obtaining cores of tissue. EBUS guided intranodal forcep biopsies (IFB) is a novel technique that can be safely and effectively used to obtain nodal tissue fragments when adequate TBNA core tissue biopsies are difficult to obtain. METHODS: Our descriptive study contains 41 patients who underwent both TNBA and EBUS guided IFB for malignant and benign diseases of the chest. A standard EBUS TBNA bronchoscopy was performed using a 22-guage Olympus® EBUS needle to obtain tissue cores. The “slow-pull” technique was utilized by slowly pulling the needle stylet out during agitations. No suction was used during the EBUS TBNA procedure. The1.2mm Boston Scientific® forceps were then passed through the puncture sites created by conventional 22-guage EBUS needles to obtain IFBs under ultrasound guidance. Five IFBs were performed per lymph node. RESULTS: Of 41 subjects, EBUS guided TBNA did not reach a diagnosis in 9 subjects and only 3 IFB subjects were not diagnosed. Using a two-sided fisher’s exact test a statistically significant result was found between diagnoses with TBNA versus diagnosis with IFB (p=0.008). Fourteen of the TBNA results diagnosed granulomas, when IFB diagnosed 18, and one granulomatous inflammation. Four subjects had TBNA results showing normal lymph node cell tissue and of the same four patients, three where diagnosed with granulomas or granulomatous inflammation with IFB. In the IFB group 10 (24.4%) of subjects had a different pathological result between TBNA and IFB. Of 41 subjects 30 (73.2%) had station 7 biopsied. EBUS guided intranodal forcep biopsy samples from all 41 patients were compared to EBUS guided TBNA during the same procedure. One complication of pneumomediastinum was present on post-procedural chest x-ray, which was not clinically significant and did not need further intervention. CONCLUSIONS: This study suggests that performing EBUS guided IFB is an effective and safe method for sampling mediastinal lymph nodes when adequate TBNA tissue cores are difficult to obtain. CLINICAL IMPLICATIONS: EBUS guided intranodal forcep biopsies may improve diagnostic yields when EBUS guided TBNA is inadequate.