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Objectives-We hypothesized that specific endobronchial ultrasound (EBUS) features may differentiate sarcoidosis from other causes of lymphadenopathy. Methods-We conducted this retrospective observational study from January 2014 to January 2019 to analyze patients with intrathoracic lymphadenopathy who underwent EBUS-guided transbronchial needle aspiration. Ultrasound features, including nodal size, margin, echogenicity, the presence or absence of calcification, a central hilar structure, the coagulation necrosis sign, nodal conglomeration, and the septal vessel sign in the color Doppler mode were recorded and compared between 3 groups. Results-Of the 90 included patients, 15 had a diagnosis of tuberculosis; 56 had a diagnosis of sarcoidosis; and 19 had a diagnosis of malignant lymph nodes by EBUS-guided transbronchial needle aspiration. The presence of nodal conglomeration (94.6% versus 60.0% versus 5.3%; P < .001), the septal vessel sign in the color Doppler mode (55.4% versus 13.3% versus 15.8%; P = .002), and a distinct margin (73.2% versus 13.3% versus 47.4%; P < .001) were significantly higher in the sarcoidosis group than in the tuberculosis lymphadenopathy and malignant lymph node groups. The presence of the coagulation necrosis sign (8.9% versus 93.3% versus 31.6%; P < .001) was significantly lower in the sarcoidosis group than in tuberculosis lymphadenopathy and malignant lymph node groups. A multivariate analysis showed that the presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode were independent predictive factors for the diagnosis of sarcoidosis. Conclusions-The presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode in lymph nodes on EBUS are predictive of sarcoidosis.

Background: Semirigid pleuroscope has good sensitivity (91%) and specificity (100%) in the diagnosis of exudative pleural effusions. However, the obtained biopsy samples by Semirigid pleuroscope are small and insufficient depth. Several studies indicated that Cryobiopsy during pleuroscope is not only safe for obtaining pleural biopsies but also the tissue obtained is larger in size, demonstrates preserved cellular architecture, and has a better diagnostic yield in the diagnosis of exudative pleural effusion. The present meta-analysis aimed to evaluate the feasibility and safety of pleuroscopic cryobiopsy of the pleura compared to forceps biopsy. Methods: A systemic search of studies on pleuroscopic cryobiopsy was conducted mainly in PubMed, Medline, Embase and scopus. The standardized mean difference (SMD) of cryobiopsy (CB) sample size versus forceps biopsy (FB) was the primary outcome, whereas the odds ratio of diagnostic yield and artifact-free sample of CB versus FB comprised the secondary outcome. Results: The meta-analysis included one randomized controlled trail, four prospective comparative studies, and three retrospective comparative studies compromising 414 patients in total. The CB biopsies were significantly larger than FB biopsies. (SMD: 0.867; 95% confidence level [CI]: 0.427 to 1.308; p < 0.001). The pooled odds ratio of diagnostic yield and artifact-free sample in the CB biopsies compared with the FB biopsies were 1.27 (95% CI:0.718-2.253) and 6.71 (95% CI:1.38-32.7), indicating more artifact-free sampled tissue and no inferior diagnostic yield in the CB group compared with FB group. There was no significant differences in the severity of bleeding from these studies. Conclusion: CB in medical thoracoscopy are feasibility and safe with high diagnostic yield, non-inferior FB with increased tissue size and quality.

Background Transbronchial lung cryobiopsy (TBLC) has emerged as a new bronchoscopic procedure which can improve specimen size and obtain crush artifact-free tissue to increase diagnostic yield in various diffuse parenchymal lung diseases (DPLDs). However, TBLC has been associated with a higher incidence of complications, and variability in diagnostic yield. Radial probe endobronchial ultrasound (R-EBUS) may be able to overcome these problems. We evaluated the safety and feasibility of TBLC in combination with R-EBUS to diagnose DPLDs.Methods We conducted this retrospective study at a single medical center from January 2015 to March 2019. Patients with DPLDs who underwent R-EBUS to locate target lesions and confirm the absence of adjacent vessels, followed by sampling with conventional transbronchial lung forceps biopsy (TBLB) and cryobiopsy (TBLC) were enrolled. TBLC and TBLB samples were sent to the pathology department for diagnostic analysis. The sample size, diagnostic yield and complications after the procedure were recorded.Results A total 30 patients with DPLD were analyzed, of whom 17 had diffuse lung infiltrates and 13 had pulmonary nodules/masses. The overall diagnostic rate was 80% (24/30) and the diagnostic yield increased from 46.7% with the forceps biopsy to 73.3% after adding cryobiopsy (p=0.038). Compared to conventional transbronchial biopsy with forceps, cryobiopsy provided a larger specimen and sample volume (40 mm3 vs 6 mm3; p<0.001). Twenty-two (73.3%) patients had mild bleeding, two (6.7%) had moderate to severe bleeding, and one (3%) had pneumothorax. Ten patients who initially had non-diagnostic results by TBLB received a definite diagnosis after adding TBLC. Among these patients, eight (8/10) were ultimately diagnosed with interstitial lung disease (ILD) (p<0.001).Conclusions TBLC with R-EBUS guidance increased the diagnostic yield in patients with DPLD, particularly in those with ILD. The samples obtained by TBLC were significantly larger and there were no severe complications after the procedure. Larger studies are needed to confirm the safety and feasibility of R-EBUS-guided TBLC.

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