HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen Hazelrigg Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazelrigg, S. Search for Related Content PubMed PubMed Citation Articles by Hazelrigg, S. Related Collections Mediastinum Trachea and bronchi Related Article

---

Original Articles: General Thoracic

Invited Commentary

Division of Cardiothoracic Surgery, Department of Surgery, Southern Illinois University School of Medicine, PO Box 19638, 800 N. Rutledge, Room D319, Springfield, IL 62794-9638

(Email: shazelrigg{at}siumed.edu).

This article [1] is a very nice study put together to evaluate the added value of endobronchial ultrasound-guided mini-forceps biopsies for patients with large subcarinal masses or nodes. It seems quite logical that the use of ultrasound guidance in experienced hands should enhance biopsy results. Similarly, one would suspect that a larger biopsy forceps, as compared with a smaller gauge needle, should obtain more specimen and hence a higher diagnostic yield. This study would seem to confirm these suspicions.

Criticisms of this study would include the fact that they routinely used rigid bronchoscopy when this technique could be solely performed with the use of a flexible bronchoscope. Rigid bronchoscopy, although quite safe, does carry a slightly increased risk of complications. In addition, as noted in their article, the authors' diagnostic yield with transbronchial needle aspiration for sarcoidosis was quite low, especially given the relatively large size of these lymph nodes. Finally, the comments pertaining to the cervical mediastinoscopy seem somewhat unfair. Although there are reports in the literature of a low yield with mediastinoscopy, this is not generally true in experienced hands, and is certainly not true if one is dealing with biopsies of lymph nodes 2 cm or greater in size. I would suggest that the yield is almost 100% with lymph nodes that size using mediastinoscopy.

Ultimately, I believe that the authors have provided data that support the concept that EBUS with a larger biopsy forceps is both safe and improves the diagnostic yield. Although it may become the preferred method to sample in large mediastinal nodes, I do not believe there is sufficient data in this article to show that it is superior to cervical mediastinoscopy. Further study will be required to answer that question. In addition, one wonders if this technology is as valuable for enlarged nodes at the segmental bronchial level, an area in which other techniques have generally not carried a high success rate. Overall, I believe this article is valuable and provides further support that endobronchial ultrasound, in addition to larger biopsy techniques, can improve diagnostic yields.

	References

Top References

 

1. Herth FJF, Morgan RK, Eberhardt R, Ernst A. Endobronchial ultrasound-guided miniforceps biopsy in the biopsy of subcarinal masses in patients with low likelihood of non-small cell lung cancer Ann Thorac Surg 2008;85:1874-1879.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen Hazelrigg Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazelrigg, S. Search for Related Content PubMed PubMed Citation Articles by Hazelrigg, S. Related Collections Mediastinum Trachea and bronchi Related Article