Role of EBUS-IFB in Providing High-quality Pathological Samples for a Sarcoidosis Diagnosis
Abstract
Objective Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard procedure for diagnosing mediastinal and hilar lymphadenopathy, its diagnostic yield for sarcoidosis remains suboptimal due to nodal fibrosis. Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) has emerged as a promising adjunctive technique; however, concerns remain regarding the potential for crush artifacts when using mini-forceps. This study aimed to evaluate the histological specimen quality, diagnostic utility, and safety of EBUS-IFB in patients with suspected sarcoidosis in a single institution.Methods We retrospectively analyzed 11 consecutive patients with suspected sarcoidosis who underwent EBUS-IFB after EBUS-TBNA at a single center. We assessed the specimen quality, diagnostic yield, and safety. Two pathologists independently evaluated the specimens using a validated scoring system focusing on the amount of cellular material, background blood, degree of cellular degeneration and trauma, and retention of normal architecture.Results EBUS-IFB yielded significantly higher-quality specimens than EBUS-TBNA (median total score, 7.0 vs. 4.0; p = 0.01). Notably, EBUS-IFB specimens demonstrated well-preserved tissue architecture without significant crush artifacts and significantly less blood contamination (p = 0.006). The overall diagnostic yield was 81.8% (9 of 11), and definitive diagnoses of sarcoidosis were obtained by EBUS-IFB alone in six cases. No procedure-related complications were noted.Conclusions Despite concerns regarding crush artifacts, EBUS-IFB provides high-quality, structurally intact histological specimens with minimal blood contamination compared to EBUS-TB. EBUS-IFB is a safe and effective adjunctive modality that successfully compensates for the limitations of fine-needle aspiration in sampling fibrotic lymph nodes.
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BibTeX
@article{matsuoka2026role,
title = {{Role of EBUS-IFB in Providing High-quality Pathological Samples for a Sarcoidosis Diagnosis}},
author = {Suzuka Matsuoka and Yuki Takigawa and Ken Sato and Mayu Goda and Keisuke Shiraha and Jun Nishimura and Hiromi Watanabe and Kenichiro Kudo and Tetsuya Isoda and Yoko Shinno and Keiichi Fujiwara and Takuo Shibayama},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.7892-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7892-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Role of EBUS-IFB in Providing High-quality Pathological Samples for a Sarcoidosis Diagnosis
AU - Suzuka Matsuoka
AU - Yuki Takigawa
AU - Ken Sato
AU - Mayu Goda
AU - Keisuke Shiraha
AU - Jun Nishimura
AU - Hiromi Watanabe
AU - Kenichiro Kudo
AU - Tetsuya Isoda
AU - Yoko Shinno
AU - Keiichi Fujiwara
AU - Takuo Shibayama
PY - 2026
DA - 2026/09/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.7892-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7892-26/_article
AB - Objective Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard procedure for diagnosing mediastinal and hilar lymphadenopathy, its diagnostic yield for sarcoidosis remains suboptimal due to nodal fibrosis. Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) has emerged as a promising adjunctive technique; however, concerns remain regarding the potential for crush artifacts when using mini-forceps. This study aimed to evaluate the histological specimen quality, diagnostic utility, and safety of EBUS-IFB in patients with suspected sarcoidosis in a single institution.Methods We retrospectively analyzed 11 consecutive patients with suspected sarcoidosis who underwent EBUS-IFB after EBUS-TBNA at a single center. We assessed the specimen quality, diagnostic yield, and safety. Two pathologists independently evaluated the specimens using a validated scoring system focusing on the amount of cellular material, background blood, degree of cellular degeneration and trauma, and retention of normal architecture.Results EBUS-IFB yielded significantly higher-quality specimens than EBUS-TBNA (median total score, 7.0 vs. 4.0; p = 0.01). Notably, EBUS-IFB specimens demonstrated well-preserved tissue architecture without significant crush artifacts and significantly less blood contamination (p = 0.006). The overall diagnostic yield was 81.8% (9 of 11), and definitive diagnoses of sarcoidosis were obtained by EBUS-IFB alone in six cases. No procedure-related complications were noted.Conclusions Despite concerns regarding crush artifacts, EBUS-IFB provides high-quality, structurally intact histological specimens with minimal blood contamination compared to EBUS-TB. EBUS-IFB is a safe and effective adjunctive modality that successfully compensates for the limitations of fine-needle aspiration in sampling fibrotic lymph nodes.
SN - 1349-7235
SN - 0918-2918
ER -