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Background <p>Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has limited diagnostic yield in benign mediastinal lymphadenopathy. This study aimed to assess the efficacy and safety of EBUS-guided cautery-assisted transbronchial forceps biopsy (EBUS-ca-TBFB), a technique that utilizes an electrocautery knife to create a tunneling tract at the prior TBNA site, for the diagnosis of benign mediastinal and hilar lymphadenopathy.</p> Methods <p>In this prospective, self-controlled cohort study, 14 adult patients with unexplained mediastinal or hilar lymphadenopathy clinically suspected to be benign after routine clinical, radiological, and available laboratory evaluation were consecutively enrolled between February 2023 and December 2024. Each patient underwent EBUS-TBNA followed by EBUS-ca-TBFB at the same target nodal station whenever feasible. The diagnostic yield, sensitivity, accuracy, and safety profiles of both techniques were compared.</p> Results <p>At the patient level, the diagnostic yield of EBUS-ca-TBFB was significantly higher than that of EBUS-TBNA (85.7% [12/14] vs. 21.4% [3/14], <i>P</i> &lt; 0.001). At the lesion level, yields were also higher with EBUS-ca-TBFB (81.3% [13/16] vs. 15.0% [3/20], <i>P</i> &lt; 0.001). Sensitivity and overall accuracy were notably improved with EBUS-ca-TBFB (92.3% vs. 23.1% and 92.9% vs. 28.6%, respectively). No severe complications, such as significant bleeding, pneumothorax, or infection, were observed in any patient.</p> Conclusions <p>In this small prospective self-controlled pilot cohort, EBUS-ca-TBFB appeared to provide additional histological diagnostic value after conventional EBUS-TBNA in selected patients with suspected benign mediastinal or hilar lymphadenopathy. No severe procedure-related complications were observed. However, given the small sample size and single-center design, the diagnostic benefit and safety profile of this technique require confirmation in larger multicenter studies.</p>

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Diagnostic yield and feasibility of EBUS-guided cautery-assisted transbronchial forceps biopsy for suspected benign mediastinal and hilar lymphadenopathy: a prospective self-controlled pilot study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Changjian Lin,
  • Hong Xue,
  • Fan Zhou,
  • Daxuan Wang,
  • Lanfeng Li,
  • Xiaohong Lin,
  • Liping Huang,
  • Baosong Xie,
  • Xiaoqin Li

摘要

Background

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has limited diagnostic yield in benign mediastinal lymphadenopathy. This study aimed to assess the efficacy and safety of EBUS-guided cautery-assisted transbronchial forceps biopsy (EBUS-ca-TBFB), a technique that utilizes an electrocautery knife to create a tunneling tract at the prior TBNA site, for the diagnosis of benign mediastinal and hilar lymphadenopathy.

Methods

In this prospective, self-controlled cohort study, 14 adult patients with unexplained mediastinal or hilar lymphadenopathy clinically suspected to be benign after routine clinical, radiological, and available laboratory evaluation were consecutively enrolled between February 2023 and December 2024. Each patient underwent EBUS-TBNA followed by EBUS-ca-TBFB at the same target nodal station whenever feasible. The diagnostic yield, sensitivity, accuracy, and safety profiles of both techniques were compared.

Results

At the patient level, the diagnostic yield of EBUS-ca-TBFB was significantly higher than that of EBUS-TBNA (85.7% [12/14] vs. 21.4% [3/14], P < 0.001). At the lesion level, yields were also higher with EBUS-ca-TBFB (81.3% [13/16] vs. 15.0% [3/20], P < 0.001). Sensitivity and overall accuracy were notably improved with EBUS-ca-TBFB (92.3% vs. 23.1% and 92.9% vs. 28.6%, respectively). No severe complications, such as significant bleeding, pneumothorax, or infection, were observed in any patient.

Conclusions

In this small prospective self-controlled pilot cohort, EBUS-ca-TBFB appeared to provide additional histological diagnostic value after conventional EBUS-TBNA in selected patients with suspected benign mediastinal or hilar lymphadenopathy. No severe procedure-related complications were observed. However, given the small sample size and single-center design, the diagnostic benefit and safety profile of this technique require confirmation in larger multicenter studies.