Bronchoscopic miniforceps biopsy for mediastinal nodes

Transbronchial needle aspiration (TBNA) for histologic specimens is much more difficult than for cytologic specimens and, therefore, an adequate amount of tissue for histologic examination cannot always be obtained. We tried to obtain histologic specimens from subcarinal nodes using 1.15-mm miniforceps and evaluated the role of miniforceps biopsy (MFB) as an adjunct to TBNA to improve the yield in the sampling. The bronchial wall was first punctured by a 19-gauge TBNA needle; then the miniforceps or TBNA needle was introduced into the puncture site to obtain pathologic specimens. In 22 consecutive patients with enlarged subcarinal nodes, at least 1 sample for pathologic examination could be prepared by MFB procedures in 18 patients, by TBNA for histology in 19 patients, and by TBNA for cytology in 22 patients. A specific diagnosis was made in 12 patients. The MFB, TBNA histology, and TBNA cytology established the diagnosis in 10, 9, and 8 patients, respectively. Diagnostic tissue was obtained by MFB in 3 patients with negative histologic results from TBNA. There were no complications except for 1 case of mild pneumomediastinum. We conclude that MFB is a helpful adjunct to TBNA for histologic specimen sampling of mediastinal nodes in cases in which a satisfactory visible tissue fragment cannot be obtained by TBNA.