A Prospective Randomized Controlled Trial Comparing the Efficacy and Safety of Cup vs Alligator Forceps for Performing Transbronchial Lung Biopsy in Patients With Sarcoidosis

Sehgal, Inderpaul Singh; Bal, Amanjit; Dhooria, Sahajal; Agrawal, Parimal; Gupta, Nalini; Ram, Babu; Aggarwal, Ashutosh N.; Behera, Digambar; Agarwal, Ritesh

doi:10.1016/j.chest.2016.03.025

Cited by 22 publications

(19 citation statements)

References 8 publications

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“…It is unlikely that the alligator forceps has a better diagnostic yield compared to the cup forceps. Nonetheless, specimens obtained are larger and complication rates are lower with the former (64,70,74).…”

Section: The Role Of Transbronchial Biopsymentioning

confidence: 99%

“…One study revealed that positive EBB correlates with a more aggressive disease (63). When supplementing transbronchial biopsy, EBB was found to increase the diagnostic yield of sarcoidosis by 10-20% (62,64). Nearly 6% of all patients diagnosed with sarcoidosis actually have CBD.…”

Section: The Role Of Endobronchial Biopsy (Ebb)mentioning

confidence: 99%

“…Although the introduction of guidance improved the diagnostic yield of TBLB, it is unclear whether it added to its safety. TBLB related mortality is rare (<0.05%), while bleeding (1-4%) and pneumothorax (1-6%) constitute the main complications (3,64,(66)(67)(68)(69). Bilateral TBLBs should not be performed during the same procedure under any circumstance, because of the risk of bilateral iatrogenic pneumothoraces.…”

Section: The Role Of Transbronchial Biopsymentioning

confidence: 99%

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Interstitial lung disease: the diagnostic role of bronchoscopy

Kebbe¹,

Abdo²

2017

J. Thorac. Dis.

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Interstitial lung diseases (ILDs) form one of the most fascinating fields in pulmonary medicine. They also pose one of the greatest challenges for accurate diagnosis and proper treatment. Even within the recommended and warranted multidisciplinary approach, differentiating between one disease and another may lead to frustration, especially when proper lung tissue is not available for adequate pathological review. A surgical lung biopsy (SLB) might render enough tissue for histopathology, but this could come at the expense of high morbidity and even mortality, as in the case of usual interstitial pneumonia (UIP). Could bronchoscopy and its various techniques offer a safer and higher yield alternative? Since the very late 19th century, efforts have been made to better examine the airways, obtain tissue and treat various conditions. This resulted in the successive emergence of bronchoalveolar lavage (BAL), endobronchial and transbronchial forceps biopsies, until recently when transbronchial cryobiopsy surfaced as a nascent technique with much promise. The use of endobronchial ultrasound revolutionized the diagnosis and staging of lung cancer, while adding to the yield of other conditions such as sarcoidosis. Ongoing research, efforts and studies have continuously scrutinized the roles of various techniques in the approach to ILDs. For example, BAL seems to serve mostly to eliminate infection as an etiology or a complicating factor in the acute worsening of a fibrotic lung disease, while a predominant cellular component might be diagnostic, such as eosinophilia in eosinophilic lung disease, or lymphocytosis in hypersensitivity pneumonitis (HP). On the other hand, endobronchial biopsy's (EBB) role appears limited to sarcoidosis. As for transbronchial biopsy by forceps, the small sample size and related artifact appear to be limiting factors in making an accurate diagnosis. Recently, however, the use of cryotherapy via employing a cryoprobe in obtaining transbronchial lung biopsies is unfolding into a refined interventional method which might transform indefinitely our approach to the pathological diagnosis of the various ILDs.

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Section: The Role Of Transbronchial Biopsymentioning

confidence: 99%

Section: The Role Of Endobronchial Biopsy (Ebb)mentioning

confidence: 99%

Section: The Role Of Transbronchial Biopsymentioning

confidence: 99%

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Interstitial lung disease: the diagnostic role of bronchoscopy

Kebbe¹,

Abdo²

2017

J. Thorac. Dis.

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“…There was no significant difference in the mean size of the lymph nodes sampled. The most common lymph node sampled 171 subjects, clinically suspected sarcoidosis, screened for eligibility 21 was the station 7, followed by station 4R and 11L. The number of lymph nodes sampled and the number of passes per lymph node were similar in the 2 groups (Table 1).…”

Section: Resultsmentioning

confidence: 81%

“…Two or more lymph node stations were accessed, and at least 2 passes were obtained from each lymph node sampled. Conventional bronchoscopy procedures, including EBB and TBLB, were performed at the discretion of the bronchoscopist [7,21].…”

Section: Study Proceduresmentioning

confidence: 99%

A Randomized Trial Evaluating the Effect of 10 versus 20 Revolutions Inside the Lymph Node on the Diagnostic Yield of EBUS-TBNA in Subjects with Sarcoidosis

et al. 2018

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Background: Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is the preferred modality for sampling intrathoracic lymph nodes in patients with suspected sarcoidosis. Whether the number of revolutions of the needle inside the lymph node while performing TBNA affects the diagnostic yield is unknown. Objectives: The aim of this paper was to compare the yield of different numbers of needle revolutions (10 vs. 20) during EBUS-TBNA in sarcoidosis. Methods: Consecutive subjects with a clinicoradiological suspicion of sarcoidosis were randomized 1: 1 to undergo EBUS-TBNA with either 10 (group 1) or 20 revolutions (group 2). The primary and secondary outcomes were the diagnostic yield and adequacy of aspirates, respectively. Other outcomes were procedure duration, gross blood contamination of the aspirates, and safety of the procedure. Results: Of the 171 subjects screened, 150 (mean age 43.5 years; 47.3% women) were randomized. A mean of 2.8 (group 1: 2.8, group 2: 2.7; p = 0.37) lymph nodes were sampled per subject with a mean of 2.1 passes per node in each group (p = 0.60). Among 133 subjects finally diagnosed with sarcoidosis, there was no difference (p = 0.65) in the diagnostic yield of EBUS-TBNA between group 1 (52/65, 80.0%) and group 2 (57/68, 83.8%). Adequate aspirates were obtained in 96.9 and 97.1% of the subjects in groups 1 and 2, respectively (p = 1.00). There was no difference in the procedure duration, the proportion of subjects with grossly bloody specimens, or complications between the 2 groups. Conclusions: The diagnostic yield and specimen adequacy were not different when EBUS-TBNA was performed with 10 or 20 revolutions in subjects with sarcoidosis.

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