Tissue Adequacy and Diagnostic Yield Assessment in Malignant Lymph Nodes Using Endobronchial Ultrasound (EBUS)-Guided Miniforcep Biopsy vs. EBUS-Guided Transbronchial Needle Aspiration.

IF 3 Q2 RESPIRATORY SYSTEM

Tuberculosis and Respiratory Diseases Pub Date : 2025-07-01 Epub Date: 2025-04-03 DOI:10.4046/trd.2024.0134

Pipu Tavornshevin, Poonchavist Chantranuwatana, Vorawut Thanthitaweewat, Virissorn Wongsrichanalai, Thitiwat Sriprasart, Nophol Leelayuwatanakul

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Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a predominantly used method for lymph node (LN) metastasis assessment. This study aims to identify tissue adequacy improvement with the addition of EBUS-guided miniforcep biopsy (EBUS-MFB) to EBUS-TBNA in sampling LNs.

Methods: We assessed tissue adequacy in patients with mediastinal and hilar lymphadenopathy, comparing the combination of EBUS-MFB and EBUS-TBNA with EBUS-TBNA alone. EBUS-MFB was performed with the guide sheath (GS) dilatation technique. Tissue adequacy was a tumor cell count (TCC) of >100 and neoplastic cell neoplastic cell estimate of >25%. Further, we reported the diagnostic yield, tumor cell characteristics, and safety outcomes.

Results: Among 69 patients (74 nodes), malignant diseases were diagnosed in 41 nodes using both techniques. Tissue adequacy with EBUS-TBNA (93.8% in 30/32 nodes) was comparable with the combined group (96.9% in 31/32 nodes, p=0.317). EBUS-TBNA yielded higher TCC (84.4% with >1,000 cells) than EBUS-MFB (53.1%, p=0.004). The combined approach significantly improved the diagnostic yield in non-malignant diseases compared with EBUS-TBNA alone (97% vs. 78.8%, p=0.014). Of the 32 nodes, 20 demonstrated discordant results between EBUS-TBNA and EBUS-MFB, with EBUS-MFB correctly diagnosing six nodes that EBUS-TBNA misdiagnosed. The complication rate was low (2.9%) with only minor bleeding reported.

Conclusion: EBUS-TBNA alone and the combination of EBUS-MFB and EBUS-TBNA demonstrated comparable tissue adequacy, with EBUS-TBNA exhibiting better specimen characteristics, potentially sufficient for various molecular analyses. The addition of EBUS-MFB, performed using the GS-dilatation technique, to EBUS-TBNA improved the diagnostic yield and proved to be a safe and efficient approach, particularly in non-malignant diseases.

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与ebus引导下的TBNA相比，ebus引导下的Miniforcep活检在恶性淋巴结中的组织充分性和诊断率评估

背景：支气管超声引导下经支气管穿刺（EBUS-TBNA）是评估淋巴结转移的主要方法。本研究旨在确定在取样LNs中加入ebus引导的小钳活检（EBUS-MFB）对组织充分性的改善。方法：我们评估纵隔和肝门淋巴结病变患者的组织充分性，比较EBUS-MFB联合EBUS-TBNA与单独EBUS-TBNA。EBUS-MFB采用引导鞘（GS）扩张技术。组织充分性是指肿瘤细胞计数（TCC）为>100，肿瘤细胞百分比（NCP）估计为>25%。此外，我们报告了诊断率、肿瘤细胞特征和安全性结果。结果：69例患者（74个淋巴结）中，两种技术均诊断出41个淋巴结恶性病变。EBUS-TBNA的组织充分性（30/32淋巴结93.8%）与联合组（31/32淋巴结96.9%,P = 0.317）相当。EBUS-TBNA比EBUS-MFB （53.1%, P = 0.004）有更高的TCC（84.4%）。与单独使用EBUS-TBNA相比，联合方法显著提高了非恶性疾病的诊出率（97%比78.8%,P = 0.014）。32个节点中，有20个EBUS-TBNA与EBUS-MFB结果不一致，其中EBUS-MFB正确诊断了6个EBUS-TBNA误诊的节点。并发症发生率低（2.9%），仅有少量出血。结论：单独EBUS-TBNA和EBUS-MFB和EBUS-TBNA的组合具有相当的组织充分性，其中EBUS-TBNA具有更好的标本特征，可能足以进行各种分子分析。使用gs -扩张技术将EBUS-MFB添加到EBUS-TBNA中，提高了诊出率，并被证明是一种安全有效的方法，特别是在非恶性疾病中。

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