Transbronchial Lymph Node Forceps Biopsy as a Novel Tool in Diagnosis of Mediastinal Lymphadenopathy

Abstract

Abstract Background Differential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to variety of inflammatory, infectious, malignant reasons. Hence, it is important to establish diagnosis. Transbronchial lymph node forceps biopsy provides adequate tissue for lung cancer staging purposes, several pathologies, such as granulomatous diseases and lymphoma, that may require histologic assessment for better diagnostic definition. This study evaluated the safety and feasibility of the transbronchial forceps biopsy as a new tool for diagnosis of mediastinal lymph nodes. Methods The study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University, in collaboration with Pathology Department during the period from December 2019 to December 2020. All patient were subjected to flexible video bronchoscopy for conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy from the enlarged mediastinal lymph node (LN-TBFB). Biopsies were sent for histopathology examination. Results C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, and was not diagnostic in TB cases. Sensitivity of C-TBNA is: 61.1%. However, LN-TBFB was diagnostic in 100% of sarcoidosis and TB cases and in 85.7% of malignant cases. Sensitivity of LN-TBFB was 94.4% Conclusion lymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of minimally invasive techniques for diagnosing pathologically enlarged mediastinal lymph node.