Lymphadenopathy and Granulomas: Benignancy of Malignancy and Differential Diagnosis with Endobronchial Ultrasound-Transbronchial Needle Biopsy 19G Needle Fine-Needle Aspiration Biopsy

Abstract

Endobronchial ultrasound (EBUS) is a very useful tool for the diagnosis of lymphadenopathy of the mediastinum. Nowadays, EBUS can substitute video-assisted thoracic surgery when a 19G needle is used. Several studies have provided data for efficient diagnosis not only for lung cancer, but for also sarcoidosis, tuberculosis and lymphoma. We present five cases of EBUS-transbronchial needle biopsy 19G needle used for the diagnosis of mediastinum lymphadenopathy. We present not only the pathological diagnosis, but also the steps for the differential clinical and pathological differential diagnosis for sarcoidosis, tuberculosis, cancer metastasis, respiratory infection and lymphoma.

Cryo-Biopsy versus 19G needle versus 22G needle with EBUS-TBNA endoscopy

“…It has been previously presented that indifferent of the needle size the sample is enough for diagnosis and molecular next generation sequencing (NGS) investigation for lung cancer and other metastatic cancers in the lung parenchyma 5 , 15 , 18 . In a recent study it was observed that the 19G needle when compared to 22G needle has a larger sample size and it has a higher diagnostic sensitivity for lymphoma 19 , 20 .…”

“…In the case of endobronchial lung cancer cryo biopsies have been extensively used 14 . However; in the case of lymphadenopathy until now we have been using 22G, 21G and 19G needles as a minimal invasive technique compared to mediastinoscopy 15 . An effort has been made to acquire more sample and therefore the cryo probe 1.1mm has been used with an ERBE CRYO 2 system 16 , 17 .…”