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The Contribution of Endobronchial Ultrasound-guided Forceps Biopsy in the Diagnostic Workup of Unexplained Mediastinal and Hilar Lymphadenopathy

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Abstract

Background

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS–TBNA) provides material for the cytological diagnostic workup. To improve the evaluation of unexplained intrathoracic lymphadenopathy, the availability of material for histological evaluation would be desirable. For this purpose, the technique of endobronchial ultrasound-guided mediastinal forceps biopsy (EBUS-guided forceps biopsy) is a potentially good candidate. The aim of the present study was, using simple methodology, to establish the additional diagnostic yield provided by supplemental EBUS-guided forceps biopsy in comparison with EBUS–TBNA alone.

Methods

The data of 50 consecutive patients with mediastinal, lobar, and hilar space-consuming lesions were analyzed. In all patients, immediately following EBUS–TBNA with a 22-gauge needle, a 21-gauge forceps was introduced through the opening created in the bronchial wall and an EBUS-guided forceps biopsy performed. The improvement in the diagnostic yield was determined. The diagnostic yield of the EBUS-guided forceps biopsy in relation to the size of the biopsy specimen and that of the EBUS–TBNA in relation to the cell-block technique were determined.

Results

Combining the techniques increased the diagnostic sensitivity of the EBUS–TBNA from 50.0 to 82.0%. EBUS-guided forceps biopsies measuring ≥3 mm enabled a specific diagnosis to be established more often than did forceps biopsies <3 mm (90.9% vs. 57.1%). A cell block was prepared in 29 patients. In this case, EBUS–TBNA provided a higher diagnostic yield (65.5% vs. 28.6%) compared to cytology alone.

Conclusion

EBUS-guided forceps biopsy should be employed for the bronchoscopic diagnosis of intrathoracic lymphadenopathy of unknown etiology.

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Abbreviations

TBNA:

Transbronchial needle aspiration

EBUS:

Endobronchial ultrasound

US:

Ultrasound

References

  1. Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA, American College of Chest Physicians (2007) Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:202S–220S

    Article  PubMed  Google Scholar 

  2. Medford AR, Agrawal S, Free CM, Bennett JA (2010) A prospective study of conventional transbronchial needle aspiration: performance and cost utility. Respiration 79:482–489

    Article  PubMed  CAS  Google Scholar 

  3. Varela-Lema L, Fernández-Villar A, Ruano-Ravina A (2009) Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J 33:1156–1164

    Article  PubMed  CAS  Google Scholar 

  4. Anantham D, Koh MS, Ernst A (2009) Endobronchial ultrasound. Respir Med 103:1406–1414

    Article  PubMed  Google Scholar 

  5. Garwood S, Judson MA, Silvestri G, Hoda R, Fraig M, Doelken P (2007) Endobronchial ultrasound for the diagnosis of pulmonary sarcoidosis. Chest 132:1298–1304

    Article  PubMed  Google Scholar 

  6. Oki M, Saka H, Kitagawa C, Tanaka S, Shimokata T, Kawata Y, Mori K, Kajikawa S, Ichihara S, Moritani S (2007) Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology 12:863–868

    Article  PubMed  Google Scholar 

  7. Tremblay A, Stather DR, Maceachern P, Khalil M, Field SK (2009) A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest 136:340–346

    Article  PubMed  Google Scholar 

  8. Nakajima T, Yasufuku K, Kurosu K, Takiguchi Y, Fujiwara T, Chiyo M, Shibuya K, Hiroshima K, Nakatani Y, Yoshino I (2009) The role of EBUS–TBNA for the diagnosis of sarcoidosis—comparisons with other bronchoscopic diagnostic modalities. Respir Med 103:1796–1800

    Article  PubMed  Google Scholar 

  9. Yasufuku K, Nakajima T, Fujiwara T, Yoshino I, Keshavjee S (2011) Utility of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology. Ann Thorac Surg 91:831–836

    Article  PubMed  Google Scholar 

  10. Wong M, Yasufuku K, Nakajima T, Herth FJ, Sekine Y, Shibuya K, Iizasa T, Hiroshima K, Lam WK, Fujisawa T (2007) Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis. Eur Respir J 29:1182–1186

    Article  PubMed  CAS  Google Scholar 

  11. Nakajima T, Takahashi R, Shingyoji M, Hirata T, Itami M, Matsui Y, Itakura M, Iizasa T, Kimura H (2011) Comparison of 21-gauge and 22-gauge aspiration needle during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS–TBNA). Respirology 16(1):90–94

    Article  PubMed  Google Scholar 

  12. Natu S, Hoffman J, Siddiqui M, Hobday C, Shrimankar J, Harrison R (2010) The role of endobronchial ultrasound-guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience. J Clin Pathol 63:445–451

    Article  PubMed  CAS  Google Scholar 

  13. Herth FJ, Morgan RK, Eberhardt R, Ernst A (2008) Endobronchial ultrasound-guided miniforceps biopsy in the biopsy of subcarinal masses in patients with low likelihood of non-small cell lung cancer. Ann Thorac Surg 85:1874–1878

    Article  PubMed  Google Scholar 

  14. Oki M, Saka H, Sako C (2004) Bronchoscopic miniforceps biopsy for mediastinal nodes. J Bronchol 11:150–153

    Article  Google Scholar 

  15. Prakash UB (2005) A better bronchoscopic technique to obtain diagnostic tissue from mediastinal lymph nodes. J Bronchol 12:1–2

    Article  Google Scholar 

  16. Gasparini S, Zuccatosta L, Sediari M, Mei F (2009) Pilot feasibility study of transbronchial needle forceps: a new tool for obtaining histology samples from mediastinal subcarinal lymph nodes. J Bronchol 16:183–187

    Google Scholar 

  17. Erwin BC, Brynes RK, Chan WC, Keller JW, Phillips VM, Gedgaudas-McClees RK (1986) Percutaneous needle biopsy in the diagnosis and classification of lymphoma. Cancer 57:1074–1078

    Article  PubMed  CAS  Google Scholar 

  18. Fritscher-Ravens A, Petrasch S, Reinacher-Schick A, Graeven U, König M, Schmiegel W (1999) Diagnostic value of endoscopic ultrasonography-guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy. Respiration 66:150–155

    Article  PubMed  CAS  Google Scholar 

  19. Varghese LR, Stanley MW, Wakely PE Jr, Lucido ML, Mallery S, Bardales RH (2005) A case report of anthracosilicotic spindle-cell pseudotumor of mediastinal lymphnode: cytologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol 33:268–272

    Article  PubMed  Google Scholar 

  20. Naccache JM, Monnet I, Nunes H, Billon-Galland MA, Pairon JC, Guillon F, Valeyre D (2008) Anthracofibrosis attributed to mixed mineral dust exposure: report of three cases. Thorax 63:655–657

    Article  PubMed  Google Scholar 

  21. Brincker H (1992) Interpretation of granulomatous lesions in malignancy. Acta Oncol 31:85–89

    Article  PubMed  CAS  Google Scholar 

  22. Sugio K, Inoue T, Yokoyama H, Ishida T, Nakano S, Sugimachi K (1993) Sarcoid reactions in regional lymph nodes of primary lung cancer. Respiration 60:133–136

    Article  PubMed  CAS  Google Scholar 

  23. Cohen PR, Kurzrock R (2007) Sarcoidosis and malignancy. Clin Dermatol 25:326–333

    Article  PubMed  Google Scholar 

  24. Thoennissen NH, Schliemann C, Hungermann D, Bremer J, Juergens KU, Semik M, Muller-Tidow C, Zuehlsdorf M, Berdel WE (2008) Solitary plasmacytoma of the lung with coexisting sarcoid-like lesions. Ann Hematol 87:417–420

    Article  PubMed  CAS  Google Scholar 

  25. Piscioli I, Donato S, Morelli L, Del Nonno F, Licci S (2008) Renal cell carcinoma with sarcomatoid features and peritumoral sarcoid-like granulomatous reaction: report of a case and review of the literature. Int J Surg Pathol 16:345–348

    Article  PubMed  Google Scholar 

  26. Kandemir NO, Yurdakan G, Bektas S, Tekin NS (2009) Classic Kaposi sarcoma with sarcoid-like granulomas: a case report and literature review. Exp Mol Pathol 87:89–93

    Article  PubMed  Google Scholar 

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The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Pneumology and Critical Care Medicine, Helios Klinik Ambrock, Witten/Herdecke University, Ambrocker Weg 60, 58091, Hagen, Germany

    Karl-Josef Franke, Christiane Bruckner, Karl-Heinz Ruhle & Georg Nilius

  2. ERBE Research, Waldhoernlestrasse 17, 72070, Tuebingen, Germany

    Mara Szyrach

  3. Institute of Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany

    Dirk Theegarten

Authors
  1. Karl-Josef Franke
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  2. Christiane Bruckner
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  3. Mara Szyrach
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  4. Karl-Heinz Ruhle
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  5. Georg Nilius
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  6. Dirk Theegarten
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Correspondence to Karl-Josef Franke.

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Franke, KJ., Bruckner, C., Szyrach, M. et al. The Contribution of Endobronchial Ultrasound-guided Forceps Biopsy in the Diagnostic Workup of Unexplained Mediastinal and Hilar Lymphadenopathy. Lung 190, 227–232 (2012). https://doi.org/10.1007/s00408-011-9341-0

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