C23-15 Endobronchial Ultrasound Bronchoscopy Standard Fine Needle Versus Franseen Core Needle in Diagnosis of Benign Lymphadenopathy

Rationale Endobronchial ultrasound bronchoscopy (EBUS) with transbronchial needle aspiration (TBNA) is recommended by current guidelines as the first diagnostic test to perform in the evaluation of sarcoidosis and in the evaluation of other causes of benign mediastinal lymphadenopathy. However, some studies suggest that the yield of EBUS TBNA for Sarcoidosis may be between 14-54%. Prior data has suggested that the Franseen EBUS needle may increase diagnostic yield of Sarcoidosis by 40%. We performed a retrospective comparative analysis of the standard FNA needle versus the Franseen needle in the diagnosis of benign lymphadenopathy. Methods EBUS cases performed between February 1st, 2020 to October 1st 2024 at our institution using both the Franseen Biopsy Needle and the Olympus 22G Standard FNA needle at the same lymph node were screened for study entry. Pathology reports were reviewed for only non-cancer diagnoses. FNA and FNB biopsies of the same lymph node were required. A benign diagnosis was defined by specific pathology such as non-caseating or caseating granulomas, presence of fungal hyphae or fungal forms; or a description of benign nodal tissue. Patient demographics including age, race/ethnicity, sex, smoking status/history, diagnosis of sarcoidosis, lymph node size on EBUS and location on CT scan, PET testing and standard uptake value (SUV), and pathologist were recorded. Descriptive statistics was used to present demographic and clinical data. Differences in proportions between FNA and FNB were assessed using a chi-square test for equality of proportions. Predefined subgroup analysis was performed and presented as a forest plot showing difference in positive proportions with 95% Confidence Intervals. Results A total of 92 patients with 102 lymph node targets were identified. The average (SD) age was 63(97) and 52% were female. Only 37% patients had a pre-procedure PET scan. The mean (SD) lymph node size (mm) was 13(8)mm. The most common lymph node sites sampled were station 7 and 4R (61.8% and 16.7%, respectively). FNB had a higher diagnostic yield than FNA, 87.3% (89/102) versus 46.1% (47/102), p < 0.0001, 95% CI 0.29-0.54. Subgroup analysis that included SUV > 10 or < 10, presence of calcified lymph node (yes/no) and reading pathologist did not demonstrate factors associated with increased diagnostic yield. Conclusions In this retrospective comparative study, FNB was associated with a substantially higher diagnostic yield than FNA in benign lymphadenopathy independent of PET avidity, lymph node size, presence of calcification or reading pathologist. This abstract is funded by: none