B80-4-27 Diode Laser-Assisted EBUS Biopsy: A Retrospective Case Series

Introduction Lung cancer remains the leading cause of cancer related mortality and morbidity both in United States of America, and worldwide. Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is central to the diagnosis and management of lung cancer. Diode laser with 1470 nanometer wavelength has shown to have hemostatic properties when used in airway procedures by coagulating small blood vessels during tissue ablation or incision. Methods We conducted a single center retrospective case series to evaluate the use of a 1470 nm diode laser to facilitate tissue acquisition using EBUS-guided transbronchial cryobiopsy (EBUS-TBCB) and EBUS-guided transbronchial forceps biopsy (EBUS-TBFB).The diode laser was employed in cases where the cryoprobe or biopsy forceps could not be advanced to the target lesion through conventional means. Laser application was intended to create a tract to improve access and enhance the diagnostic yield. Results A total of 39 patients:18% (7/39) underwent only LA-EBUS-TBCB, 49% (19/39) underwent only LA-EBUS-TBFB, while 36% (14/39) underwent both procedures. Overall, 54% (21/39) of patients had LA-EBUS-TBCB and 85% (33/39) had LA-EBUS-TBFB performed. The median age of patients was 65 years, with a mean age of 64 years with 54% (21/39) males and 46% (18/39) females. Lymph node sampling was performed in 72% (28/39) of patients. Of these, 7% (2/28) had two lymph nodes sampled, while 93% (26/28) had a single node sampled. The most frequently sampled stations were 4R and 7, each in 46% (13/28) of cases, followed by 11L in 7% (2/28), 11R in 4% (1/28), and the right supra-hilar node in 4% (1/28). Lung mass or nodule sampling via LA-EBUS was performed in 28% (11/39) of cases. Overall diagnostic adequacy was achieved in 97% (38/39) of cases. No patients experienced bronchospasm, airway edema, procedure-related death, or fire events, 8% (3/39) patients had mild oozing of blood which was controlled with cold saline instillation. Conclusion Laser-assisted endobronchial ultrasound appears to be a safe and feasible technique for tissue acquisition. Importantly, no fire-related events, airway injuries, or procedure-related mortalities were observed. These findings support the potential utility of this technique; however, larger prospective studies are needed to better define its safety profile, optimize technique parameters, and establish its diagnostic and therapeutic value.