Improved Diagnostic Yield and Specimen Quality with EBUS-Guided Forceps Biopsies: A Retrospective Analysis

Abstract Background Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) has a high diagnostic yield when evaluating mediastinal and hilar lymphadenopathy (LAD). Having previously demonstrated the safety of EBUS-guided cautery-assisted transbronchial nodal forceps biopsy (ca-TBFB)1, we herein report disease-specific improvements in diagnostic yield and tissue acquisition when supplementing EBUS-TBNA-based standard of care (SOC) with ca-TBFB. Methods We retrospectively reviewed 213 patients who sequentially underwent SOC and ca-TBFB during the same procedure. We determined three clinical scenarios of interest based on pre-procedural imaging: isolated mediastinal/hilar lymphadenopathy (LAD), LAD associated with a nodule or mass suspicious for malignancy and LAD associated with parenchymal findings suggestive of sarcoidosis. Using validated methods, we assessed diagnostic yield on a per-patient basis and specimen quality on a per-node basis on the 136 patients meeting diagnostic criteria. Results Administration of disease-specific SOC with ca-TBFB yielded gains that varied by diagnosis. Of the 61 patients diagnosed with solid organ malignancy, diagnostic yields of SOC and its supplementation with ca-TBFB were 91.8% and 93.4% (p-value 0.50). Of the 59 patients diagnosed with sarcoidosis, the corresponding yields were 62.7% and 94.9% (p-value Conclusions We suggest that relative to SOC, ca-TBFB improves diagnostic yield for sarcoidosis and lymphoma while providing uniformly better tissue quality and cellularity. We propose a protocol for use of this innovative technique.