Pneumologie 2024; 78(S 01): S19
DOI: 10.1055/s-0044-1778764
Abstracts
Endoskopie – Bronchoskopie und Interventionelle Pneumologie

EBUS-guided cryo-biopsy in malignant mediastinal lymphoma

Authors

  • A Schulze

    1   Universitätsklinikum Münster; Medizinische Klinik A – Sektion Pneumologie

  • M Mohr

    2   Universitätsklinikum Münster; Innere Medizin A; Pneumologische Ambulanz

  • J Galonska

    1   Universitätsklinikum Münster; Medizinische Klinik A – Sektion Pneumologie

  • W Hartmann

    3   Gerhard Domagk Institut für Pathologie, Universitätsklinikum Münster; Gerhard Domagk Institute of Pathology, University Hospital Muenster, 48149 Muenster, Germany; Sektion für Translationale Pathologie

  • G Lenz

    4   Medizinische Klinik A – Hämatologie und Onkologie

  • G Evers

    5   Universitätsklinikum Münster; Medizinische Klinik A, Schwerpunkt Pneumologie; Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, 48149 Muenster, Germany
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Introduction Endobronchial ultrasound (EBUS) guided trans-bronchial needle aspiration (TBNA) is a commonly used technique to assess mediastinal lymph nodes. However, diagnostic yield of TBNA-gathered cytological aspirates in lymphoma diagnosis is limited. While mediastinoscopy is far more invasive, we retrospectively assessed the role of EBUS-guided cryo-biopsy in this subset.

Methods Between 12/2021 and 09/2023 we gathered 27 cases in suspicion of malignant lymphoma, relapse, or progress under treatment to evaluate the diagnostic accuracy of EBUS-guided cryo-biopsies. Our technique includes an over-the-scope insertion of a flexible interventional tube, a high-frequency needle-knife electrocautery as well as the insertion of a 1.1 mm cryo-probe under EBUS sight.

Results 33.3% of patients were female, mean age at EBUS was 56.9 years. Nine patients underwent EBUS in high suspicion of initial lymphoma diagnosis, whereas 18 patients were suspected of lymphoma progression or relapse. Diagnosed malignant lymphoma included Hodgkin’s lymphoma (n=5), small lymphocytic lymphoma (n=2), diffuse large B-cell lymphoma (n=2), follicular lymphoma grade 1/2 (n=1), hairy cell leukemia (n=1) and post-transplant lymphoproliferative disorder (n=1). Most frequent non-malignant diagnoses were sarcoid like lesions and/ or epithelioid granulomatosis (n=5), anthracosis/ histiocytosis (n=5), and altered non-monoclonal lymphoid tissue (n=4). One patient was diagnosed a systemic leishmaniosis. In two patients a subsequent mediastinoscopy stated an anthracosis/histiocytosis diagnosis.

Conclusion If accessible via EBUS, transbronchial cryo-biopsy is a safe, feasible and reliable tool to assess tissue in suspicion of malignant lymphoma. Histopathologic workup allowed accurate classification of lymphoma disease and subtype. Regarding sensitivity, specificity and harm of the performed interventions, prospective studies should compare mediastinoscopy and EBUS-guided cryo-biopsy in this context.



Publication History

Article published online:
01 March 2024

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