Abstract Rationale Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard for mediastinal lymph node diagnosis, but often yields insufficient tissue for histology. While combining EBUS-TBNA with intra-nodal forceps biopsy (IFB) has shown promise, prior studies have used various needle and forceps combinations. This study evaluates the impact of a specific approach: a 19G Olympus Vizishot needle followed by 1.2mm CoreDX Boston Scientific forceps. Methods We retrospectively reviewed 82 adult patients (≥18 years) who underwent endobronchial ultrasound-guided TBNA of 290 mediastinal lymph node (LN) stations. All procedures used the 19G needle plus 1.2 mm forceps. Adequate sampling was defined as benign lymph node tissue or a clear diagnosis. Inadequate sampling was defined as no lymph node tissue and no alternative diagnosis. Statistical analysis (χ2 and Fisher exact tests) was performed using Minitab, with p 0.05 considered significant. Results The study included 290 lymph node biopsies from 82 patients (53.66% female). Malignancy was diagnosed in 21.38% (n = 62) of nodes, and other benign diseases in 16.89% (n = 49). Notably, the addition of 1.2mm IFB significantly reduced inadequate sampling from 14.14% (n = 41) with TBNA alone to 4.83% (n = 14) (p 0.001), increasing overall sampling adequacy from 85.86% to 95.17%. The combined approach (TBNA+IFB) significantly increased the overall diagnostic yield to 38.28% (n = 111) compared to TBNA alone (26.55%, n = 77) (p = 0.003). This improvement was driven by improved yields in benign disease (49% vs. 19%, p 0.001). Out of 62 malignant lymph nodes sampled, adequacy data for molecular studies was available in 59 lymph nodes. For malignant LNs, tissue sufficiency for molecular studies increased from 67.80% to 79.66% but did not reach statistical significance (p = 0.143). Importantly, no complications (pneumomediastinum, pneumothorax, or hemorrhage) were observed in our cohort. Conclusions Our study demonstrates that combining a 19G needle with 1.2mm forceps significantly improves the adequacy and diagnostic yield of EBUS-TBNA, particularly in benign disease, without increasing complications. These findings suggest that this specific approach may be an effective and safe strategy for mediastinal lymph node evaluation, potentially obviating the need for more complex techniques such as electrocautery or cryobiopsy. Future research should compare different forceps sizes and novel biopsy methods head-to-head and aim to develop standardized protocols for widespread clinical implementation. This abstract is funded by: none
Kumar et al. (Fri,) studied this question.