Endobronchial Ultrasound-Guided Fine Needle Biopsy in the Diagnosis of Mediastinal Lymphadenopathy
Ajmal Khan, Atul Tiwari, Mansi Gupta, Zia Hashim, Alok Nath, Vinita Agrawal, Ojas Gupta, Anup KumarBackground:
The comparative sampling efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needles in mediastinal lymphadenopathy remains unclear. Would the fine needle biopsy (FNB), with its Franseen design, provide better results than the fine needle aspiration (FNA) during EBUS-TBNA?
Methods:
We performed a single-center, investigator-initiated, single-blinded, randomized, parallel-group, superiority trial between August 2022 and July 2023. Consecutive patients were randomly assigned (1:1) to undergo EBUS-TBNA with either 19-gauge (G) FNA or 22-G FNB. The primary endpoint was the diagnostic yield, while the secondary endpoints were specimen adequacy and complication rates.
Results:
The study included 150 patients with a mean age of 44.5±15.1 years (50.7% female patients). The diagnostic yield of FNB was not significantly different from FNA (94.7% vs. 89.3%; difference, 5.4%; 95% CI: −4.0% to 15.0%;
Conclusion:
Despite similar diagnostic yields, FNB was more effective than FNA in providing larger, adequate core tissue samples. This improvement in specimen quality may suggest a potential clinical benefit for comprehensive diagnosis and advanced pathologic work-up.