Endoscopic ultrasound-guided fine-needle aspiration and Trucut biopsy in thoracic lesions: When tissue is the issue

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS FNA) has a high accuracy in the evaluation of mediastinal lesions. The use of a core biopsy needle for EUS guided biopsy (EUS TCB) may further improve the yield of EUS. The aims of this study are to evaluate the safety of EUS TCB in thoracic lesions and to compare the diagnostic accuracy of TCB with FNA and FNA + TCB. Methods: A single-center retrospective study. All patients underwent EUS-FNA and TCB. A cytopathologist was not present during the procedure. EUS FNA, TCB and FNA + TCB diagnostic accuracy were compared. Results: A total of 48 patients were included. The lesions sampled included 41 lymph nodes (six aorto-pulmonary window, 32 subcarinal, two right paratracheal, one paraesophageal ATS station 8), five lung masses, and two esophageal masses. Twenty-nine patients had malignant disease and 19 had benign disorders. The overall diagnostic accuracy of FNA, TCB and FNA + TCB was 79%, 79% and 98% respectively (p = 0.007). TCB changed the diagnosis in nine cases missed by FNA. EUS TCB was better than FNA for benign diseases (89% vs. 63%, p = 0.04). All eight patients with a prior failed biopsy had a correct diagnosis established by EUS. No patient required mediastinoscopy or thoracoscopy after EUS. Conclusion: The combination of TCB and FNA is superior to FNA alone. EUS-guided TCB should be considered in patients with benign disorders of the mediastinum when other modalities fail to yield a diagnosis.