Utility of ultrasound-guided transbronchial needle biopsy using an acquire needle in the diagnosis of chest and mediastinal diseases.

Abstract

Background: Recently, a transbronchial needle biopsy (TBNB) method using a three-plane symmetric Acquire needle with Franseen geometry was developed to improve diagnostic yield. This study describes our experience with Endobronchial ultrasound (EBUS)-TBNB for pulmonary and mediastinal diseases.

Methods: A retrospective review was conducted involving 37 patients who underwent EBUS-TBNB with an Acquire 22G needle between July 2021 and September 2024. Enlarged lymph nodes were sampled, and medical records were analyzed to evaluate diagnostic outcomes, including histological core tissue acquisition, programmed death-ligand 1 (PD-L1) expression testing, and next-generation sequencing (NGS).

Results: We sampled a total of 48 lymph nodes (26 subcarinal [#7], 12 right lower paratracheal [#4R], and 10 right hilar [#11]) with a median longest diameter of 23.1 mm (range, 9.3-44.6 mm). Definitive diagnoses were achieved in 36 patients, including 25 cases of lung cancer, one large-cell neuroendocrine carcinoma, one renal cell carcinoma, five cases of sarcoidosis, and four cases of unspecified lymphadenopathy. The overall diagnostic yield was 97.3% (95% confidence interval: 85.8%-99.5%). Both PD-L1 expression testing and NGS were successfully performed in all lung adenocarcinoma cases (nine using the Oncomine Dx Target Test and four using the AmoyDx Pan Lung Cancer polymerase chain reaction (PCR) Panel). Histological samples were successfully obtained from 35 patients, whereas only two cases of lung squamous cell carcinoma were cytologically diagnosed due to necrotic and calcified samples. The nucleic acid yield from a single puncture was sufficient for analysis using the Lung Cancer Compact Panel.

Conclusions: EBUS-TBNB demonstrated high efficacy for diagnosing lung cancer, including PD-L1 testing and NGS, and for obtaining histological core tissue.