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

• DOI: 10.1111/resp.14659
• Publication Date: 2024-01-22T03:50:08Z
• Authors: Toshiyuki Nakai; Yuji Matsumoto; Takahiro Ueda; Yuko Kuwae; Sayaka Tanaka; Atsushi Miyamoto; Yoshiya Matsumoto; Kenji Sawa; Kanako Sato; Kazuhiro Yamada; Tetsuya Watanabe; Kazuhisa Asai; Hideaki Furuse; Keigo Uchimura; Tatsuya Imabayashi; Riki Uenishi; Mitsuru Fukui; Hidenori Tanaka; Masahiko Ohsawa; Tomoya Kawaguchi; Takaaki Tsuchida
• Keywords: Image-Guided Biopsy; Lung Neoplasms; Mediastinum; Lymphadenopathy; Surgical Instruments; 03 medical and health sciences; 0302 clinical medicine; Bronchoscopy; Humans; Prospective Studies; Lymph Nodes; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Retrospective Studies

AbstractBackground and ObjectiveEndobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a diagnostic procedure with adequate performance; however, its ability to provide specimens of sufficient quality and quantity for treatment decision‐making in advanced‐stage lung cancer may be limited, primarily due to blood contamination. The use of a 0.96‐mm miniforceps biopsy (MFB) permits true histological sampling, but the resulting small specimens are unsuitable for the intended applications. Therefore, we introduced a 1.9‐mm standard‐sized forceps biopsy (SFB) and compared its utility to that of MFB.MethodsWe prospectively enrolled patients from three institutions who presented with hilar/mediastinal lymphadenopathy and suspected advanced‐stage lung cancer, or those who were already diagnosed but required additional tissue specimens for biomarker analysis. Each patient underwent MFB followed by SFB three or four times through the tract created by TBNA using a 22‐gauge needle on the same lymph node (LN). Two pathologists assessed the quality and size of each specimen using a virtual slide system, and diagnostic performance was compared between the MFB and SFB groups.ResultsAmong the 60 enrolled patients, 70.0% were diagnosed with adenocarcinoma. The most frequently targeted sites were the lower paratracheal LNs, followed by the interlobar LNs. The diagnostic yields of TBNA, MFB and SFB were 91.7%, 93.3% and 96.7%, respectively. The sampling rate of high‐quality specimens was significantly higher in the SFB group. Moreover, the mean specimen size for SFB was three times larger than for MFB.ConclusionSFB is useful for obtaining sufficient qualitative and quantitative specimens.