Abstract
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 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.