To evaluate the diagnostic yield and safety of a novel method, endobronchial ultrasound-guided cautery-assisted transbronchial forceps biopsy (EBUS-caTBFB) to discriminate the etiologies of mediastinal lymphadenopathy.

Patients admitted in Xinqiao Hospital with mediastinal lymphadenopathy between December 2018 and December 2019 were included in this study. For each of them, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and EBUS-caTBFB were sequentially performed to acquire specimens for pathologic diagnosis. Diagnostic yield and the incidence of complications were compared between the two methods.

15 patients with 8 of malignant cases (3 of adenocarcinoma cases, 2 of squamous carcinoma cases and 1 of unclassified case), 4 of benign cases (1 of inflammatory pseudotumor case and 3 of tuberculosis cases) and 3 of unclear chronic granulomatous inflammation were included. The EBUS-caTBFB tend to has a better pathological diagnostic yield than EBUS-TBNA, with respective rate of 86.7%(13/15)and 53.3%(8/15)(P=0.054). Among the 12 cases diagnosed with definite etiologies, the EBUS-caTBFB also seemed to have a higher etiological diagnostic yield than EBUS-TBNA as the rate was 50.0% (6/12) versus 83.3% (10/12) but without significant difference. The overall diagnostic yield of the two methods was 93.3%(14/15)in pathology and 91.7% (11/12) in etiology. Complications including pneumothorax, severe bleeding and infections were not encountered.

EBUS-caTBFB may be a safe and effective method compared to EBUS-TBNA to obtain specimens for mediastinal adenopathy diagnosis. Furthermore, the combination of the two methods may further improve the overall diagnostic yield.