Do you have any strategies for increasing yield while doing bronchoscopic biopsy with EBUS?

At least 4 passes with the EBUS needles per lymph node station, use CoreDx forceps on lymph nodes over 15 mm in size and cryobiopsies of the largest lymph nodes for suspected sarcoidosis or lymphoma.

Rapidly advancing the needle forward during agitation while performing EBUS can improve sample quantity. Tumor cells are often very sticky, so keeping the needle on the same plane allows it to first shear the cells from the surrounding tissue. The repeated back-and-forth motion, combined with suction, then helps collect the dislodged cells more effectively.

Well, there are multiple factors that can help with improved yield, ranging from the skills of the team (NOT just the bronchopist), ROSE and even sample processing and the cytopathologist reading the sample. It will be a whole book chapter to go through all factors. I will just focus on the number of passes.

While 3-4 passes are sufficient, one cannot depend on the number of passes alone. Even when our ROSE tells us that they see tumor cells, we continue to sample that specific LN, even up to 5-...

I am not sure of the question and assume it means TBNA sampling yield.

1. Foundational concepts and stick to it.
2. If you have ROSE, then get feedback from Cytopathology team - if they are not seeing lymphocytes, then you need to work on your technique and not their eyes.
3. Follow up on your cell block results. If you are seeing good cell block but poor ROSE, then consider using the stylet method for cytology and suction method for Cell Block.

Happy to discuss if you need additional assistance.