Feasibility of Modified Endobronchial Ultrasound-Guided Intranodal Forceps Biopsy: A Retrospective Analysis

Abstract

<b><i>Background:</i></b> Endobronchial ultrasound (EBUS)-guided intranodal forceps biopsy (IFB), a diagnostic bronchoscopic technique for intrathoracic lymphadenopathy, is performed following EBUS-guided transbronchial needle aspiration (TBNA). The current EBUS-IFB technique is complex and provides small sample volumes. We modified this technique to allow the use of standard-sized forceps. <b><i>Objectives:</i></b> The aim of this study was to assess the feasibility of the modified EBUS-IFB technique, which combines standard-sized forceps with standard EBUS-TBNA equipment. <b><i>Method:</i></b> This retrospective analysis included consecutive patients scheduled for EBUS-TBNA with attempted additional IFB between July 2020 and March 2021. The feasibility indices of IFB, technical success rate, diagnostic accuracy, and major complications were retrospectively investigated. We performed semi-quantitative evaluation of the histological specimens and univariable analyses to identify factors associated with IFB failure. <b><i>Results:</i></b> During the study period, 295 patients underwent 307 EBUS-TBNAs; 195 cases were included in the analyses. Target lesions were mainly mediastinal lymph nodes (134 cases, 68.7%); the most frequent sites were #7 (61 cases) and #4R (50 cases). The median lesion size was 16.1 mm, the technical IFB success rate was 90.8%, and the diagnostic accuracy of the TBNA and IFB combination was 99.5%. One patient was lost to follow-up. Univariable analyses did not identify any factors involved in technical IFB failure. Major complications of pneumonia and pneumothorax occurred in 2 cases (1.0%). The median histological score was significantly higher in the IFB group than in the TBNA group (1.67 vs. 1.50, <i>p</i> = 0.032). <b><i>Conclusions:</i></b> Modified EBUS-IFB, combining standard-sized forceps with common EBUS-TBNA equipment, is feasible with few major complications.

Thoracic SMARCA4‐deficient undifferentiated tumor diagnosed by transbronchial mediastinal cryobiopsy: A case report

“…The high success rate of a high‐frequency needle‐knife incision technique has been demonstrated in two large randomized controlled trials 7,9 . In our case, the puncture hole was widened by tunneling with the needle alone using a combination of angulation and rotational maneuvers 11 . This modified EBUS‐IFB technique has also demonstrated a high technical IFB success rate of 90.8% (177/195).…”

“… 7 , 9 In our case, the puncture hole was widened by tunneling with the needle alone using a combination of angulation and rotational maneuvers. 11 This modified EBUS‐IFB technique has also demonstrated a high technical IFB success rate of 90.8% (177/195). Other reported techniques include widening the puncture hole by advancing the needle sheath 8 or establishing a working channel for EBUS‐cryo by advancing the sheath into the lesion.…”

“…Since no core tissue was obtained, an additional four specimens were obtained with 1.9‐mm forceps (FB‐231‐D, Olympus) using the modified EBUS‐IFB technique (Figure 2b ). 11 The EBUS‐IFB specimens were markedly degenerative with inflammatory cell infiltration, and a detailed diagnosis beyond poorly differentiated carcinoma (Figure 2c,d ) could not be obtained. The carcinoma was diagnosed as clinical T1bN1M0 stage IIB; however, the patient experienced a stroke preoperatively.…”

Suitability of respiratory endoscopy for sampling malignant thoracic tumors for comprehensive genomic profiling

“…We believe that the tumor cell content was higher with EBUS‐TBNA than with other sampling methods for three reasons. First, when TBNA is performed, the stromal component is less likely to be aspirated, resulting in a greater likelihood of cellular components in the specimen 30 . Second, red blood cells, which are frequently contaminated, are not included in the population of the tumor cells and the evaluated area of the section itself as they are not nucleated cells (Figure 5C,D).…”

Comparison of the specimen quality of endobronchial ultrasound‐guided intranodal forceps biopsy using standard‐sized forceps versus mini forceps for lung cancer: A prospective study

“…Specimen quality is higher with the modified EBUS-IFB technique than with TBNA. 9 The use of the standard-sized forceps during EBUS-IFB is expected to yield better quality specimens than the miniforceps. Such an improvement could contribute to selecting appropriate therapeutic agents for patients with advanced-stage lung cancer, especially in NSCLC.…”