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The Yield of EBUS-TBNA Compared to EBUS-Guided Cautery-Assisted Forceps Biopsies: A Retrospective Analysis
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A7303 - The Yield of EBUS-TBNA Compared to EBUS-Guided Cautery-Assisted Forceps Biopsies: A Retrospective Analysis
Author Block: A. S. Ray, T. E. Murphy, K. L. B. Araujo, I. B. Oliva, M. A. Pisani, K. T. Bramley, E. M. DeBiasi, J. T. Puchalski; Yale University School of Medicine, New Haven, CT, United States.
Introduction: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) has demonstrated efficacy in the diagnosis of mediastinal and hilar lymphadenopathy. We previously demonstrated the safety of EBUS-guided cautery-assisted transbronchial forceps biopsies (ca-TBFB). Herein we report the yield of ca-TBFB compared to TBNA with attention to malignancy, sarcoidosis and lymphoma.
Methods: We completed a retrospective review of patients undergoing EBUS TBNA and EBUS ca-TBFB between 2011-2016 at our tertiary care center. Of these procedures, 195 patients underwent concurrent TBNA and ca-TBFB. In addition to imaging and pathologic review, 6-month follow-up was performed to assess for subsequent procedures and complications.
Results: The diagnostic yield of ca-TBFB compared to TBNA varied depending on the diagnosis of the patient. Of the 96 patients with solid-organ malignancy, the yield of TBNA, ca-TBFB and both was 86.5%, 71.9% and 89.6%, respectively. Of the 58 patients diagnosed with sarcoid, the diagnostic yield of TBNA, ca-TBFB and both was 58.6%, 77.6%, and 89.7% respectively. Of the 13 patients with lymphoma, the diagnostic yield of TBNA, ca-TBFB and both was 38.5%, 76.9%, and 84.6% respectively.
After excluding patients who also underwent concurrent transbronchial biopsy, there were 15 total complications including pneumomediastinum (n=4), pneumonia (n=9) and respiratory failure (n=2). Given concurrent procedures, the cause of these findings is unclear.
In this cohort, 26 patients had negative results. Of these, 15 patients underwent additional biopsies to establish a diagnosis, including transthoracic biopsies (n=2) or surgery (n=1), establishing a diagnosis in 6. Of the remaining 20 patients, 9 had imaging follow-up only, 15 were alive at 6 months, 1 was dead at 6 months, and 4 were lost to follow-up.
Molecular analysis was performed in 18 of the patients undergoing ca-TBFB. Mutations identified included EGFR mutations (n=11), K-RAS mutations (n=11), and EML-ALK rearrangement (n=8).
Conclusions: Using ca-TBFB in conjunction with TBNA improved the diagnostic yield over TBNA alone in patients with lymphoma and sarcoidosis. Ca-TBFB had a lower diagnostic yield in solid organ malignancies. Complications were minor, as was the number of patients requiring additional techniques to establish the diagnosis. Additional studies are required to compare specimen quality when performing molecular analysis in this era of molecular-based therapies and immunotherapy.
Author Block: A. S. Ray, T. E. Murphy, K. L. B. Araujo, I. B. Oliva, M. A. Pisani, K. T. Bramley, E. M. DeBiasi, J. T. Puchalski; Yale University School of Medicine, New Haven, CT, United States.
Introduction: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) has demonstrated efficacy in the diagnosis of mediastinal and hilar lymphadenopathy. We previously demonstrated the safety of EBUS-guided cautery-assisted transbronchial forceps biopsies (ca-TBFB). Herein we report the yield of ca-TBFB compared to TBNA with attention to malignancy, sarcoidosis and lymphoma.
Methods: We completed a retrospective review of patients undergoing EBUS TBNA and EBUS ca-TBFB between 2011-2016 at our tertiary care center. Of these procedures, 195 patients underwent concurrent TBNA and ca-TBFB. In addition to imaging and pathologic review, 6-month follow-up was performed to assess for subsequent procedures and complications.
Results: The diagnostic yield of ca-TBFB compared to TBNA varied depending on the diagnosis of the patient. Of the 96 patients with solid-organ malignancy, the yield of TBNA, ca-TBFB and both was 86.5%, 71.9% and 89.6%, respectively. Of the 58 patients diagnosed with sarcoid, the diagnostic yield of TBNA, ca-TBFB and both was 58.6%, 77.6%, and 89.7% respectively. Of the 13 patients with lymphoma, the diagnostic yield of TBNA, ca-TBFB and both was 38.5%, 76.9%, and 84.6% respectively.
After excluding patients who also underwent concurrent transbronchial biopsy, there were 15 total complications including pneumomediastinum (n=4), pneumonia (n=9) and respiratory failure (n=2). Given concurrent procedures, the cause of these findings is unclear.
In this cohort, 26 patients had negative results. Of these, 15 patients underwent additional biopsies to establish a diagnosis, including transthoracic biopsies (n=2) or surgery (n=1), establishing a diagnosis in 6. Of the remaining 20 patients, 9 had imaging follow-up only, 15 were alive at 6 months, 1 was dead at 6 months, and 4 were lost to follow-up.
Molecular analysis was performed in 18 of the patients undergoing ca-TBFB. Mutations identified included EGFR mutations (n=11), K-RAS mutations (n=11), and EML-ALK rearrangement (n=8).
Conclusions: Using ca-TBFB in conjunction with TBNA improved the diagnostic yield over TBNA alone in patients with lymphoma and sarcoidosis. Ca-TBFB had a lower diagnostic yield in solid organ malignancies. Complications were minor, as was the number of patients requiring additional techniques to establish the diagnosis. Additional studies are required to compare specimen quality when performing molecular analysis in this era of molecular-based therapies and immunotherapy.
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