Diagnostic Yield of Endobronchial Ultrasound-Guided Mediastinal Lymph Node Transbronchial Forceps Biopsies (EBUS-TBFB)

Authors

Khalil Diab, From the Division of Pulmonary and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Christy Costanian, the Department of Biostatistics and Oncology, Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine, Blat, Lebanon.
Marvi Bikak, the Department of Pulmonary Medicine, Palos Health, Chicago, Illinois.
Nawar Al Nasrallah, the Divisions of Pulmonary and Critical Care Medicine, and Hematology and Oncology, Indiana University School of Medicine, Bloomington.
Ahmad A. Al-Hader, the Divisions of Pulmonary and Critical Care Medicine, and Hematology and Oncology, Indiana University School of Medicine, Bloomington.
Edmond Bendaly, the Department of Hematology and Oncology, Marion General Hospital, Marion, Indiana.
Chen Zhang, the Divisions of Pulmonary and Critical Care Medicine, and Hematology and Oncology, Indiana University School of Medicine, Bloomington.
Rita Assi, the Department of Biostatistics and Oncology, Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine, Blat, Lebanon.

Document Type

Journal Article

Publication Date

2-1-2023

Journal

Southern medical journal

Volume

116

Issue

2

DOI

10.14423/SMJ.0000000000001509

Abstract

OBJECTIVE: The diagnostic accuracy and yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is not well established in lymphoma and other mediastinal-related diseases. The objective of this study was to examine the yield of a combined technique of EBUS-TBNA and endobronchial ultrasound-guided transbronchial forceps biopsies (EBUS-TBFB) compared with each modality alone in lymphoma and other mediastinal-related diseases. METHODS: This was a retrospective review of cases of mediastinal lymphadenopathy of unknown etiology accessed using TBNA and TBFB. The McNemar test was used to compare the diagnostic yield of TBNA, TBFB, and the combined technique. RESULTS: The combined approach yielded a definitive diagnosis in 31/35 cases (88.6%). In 9/10 cases (90%), Hodgkin's and non-Hodgkin's lymphomas were diagnosed and subtyped without further need for invasive testing. All of the granulomatous inflammation cases were confirmed using the combined technique. Two cases led to adequate whole-genome sequencing of lung cancer, and one patient was diagnosed as having dedifferentiated liposarcoma despite a nondiagnostic preprocedural mediastinoscopy. There was only one procedure-related complication, a pneumomediastinum that required no further intervention. There were no significant adverse events. CONCLUSIONS: The combination of EBUS-TBFB and EBUS-TBNA is safe and provides a high yield in the diagnosis of mediastinal adenopathy of unknown etiology, especially lymphoma. Furthermore, the larger samples obtained from TBFB increased its sensitivity to detect granulomatous disease and provided specimens for clinical trials of malignancy when needle aspirates were insufficient.

APA Citation

Diab, Khalil; Costanian, Christy; Bikak, Marvi; Al Nasrallah, Nawar; Al-Hader, Ahmad A.; Bendaly, Edmond; Zhang, Chen; and Assi, Rita, "Diagnostic Yield of Endobronchial Ultrasound-Guided Mediastinal Lymph Node Transbronchial Forceps Biopsies (EBUS-TBFB)" (2023). GW Authored Works. Paper 2475.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2475

Department

Medicine