Respiratory medicine and research · 2026
Is endobronchial ultrasound-guided bronchoscopy (EBUS) transbronchial needle aspiration (TBNA) enough for the diagnosis of mediastinal lymphadenopathy? A cohort analysis.
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Taha Kimberly, Roll Patrice, Tronchetti Julie, Dutau Hervé, Astoul Philippe
Аннотация
INTRODUCTION: Diagnostic yields of sampling techniques for the diagnosis of mediastinal lymphadenopathy, mainly rely on transbronchial needle aspiration (EBUS-TBNA) and intranodal forceps biopsy (EBUS-IFB), vary depending on the underlying pathology. The respective roles of these two sampling techniques remain to be clearly defined.
OBJECTIVES: To compare the diagnostic yields of EBUS-TBNA and EBUS-IFB for the cytological and/or histological diagnosis of mediastinal and hilar lymphadenopathy.
STUDY DESIGN AND METHODS: A single-centre, retrospective, paired study was conducted at Hôpital Nord, Marseille (Assistance Publique-Hôpitaux de Marseille, AP-HM, Marseille, France) in patients who underwent EBUS-TBNA and EBUS-IFB performed during the same procedure on the same target lymph node for the diagnosis of mediastinal lymphadenopathy. Diagnostic yields of both sampling techniques were compared in patients for whom a definitive diagnosis was established after completion of the diagnostic work-up.
RESULTS: A total of 131 patient records were analysed. A definitive diagnosis was obtained in 101 patients after endoscopic sampling and additional investigations, predominantly malignancies (41 patients) and granulomatous diseases (54 patients). Endoscopic samples were considered adequate for interpretation in 103 patients (78%) with EBUS-IFB and in 114 patients (87%) with EBUS-TBNA. In 70 patients (69%), bronchoscopy alone provided a definitive diagnosis without the need for further investigations, 61 diagnoses were obtained by EBUS-IFB and 28 by EBUS-TBNA (p = 10⁻⁷). Among the 41 malignant cases, diagnoses were established in 22 patients using EBUS-IFB and in 25 patients using EBUS-TBNA. EBUS-IFB enabled the diagnosis of granulomatous disease in 39 patients, compared with only 3 patients using EBUS-TBNA (p = 10⁻⁵). Two procedures were complicated by minor bleeding.
CONCLUSION: In this retrospective, single-centre study, EBUS-IFB was associated with a higher diagnostic yield for mediastinal lymphadenopathy, with a significant benefit observed in selected patients with granulomatous diseases. No additional diagnostic benefit of EBUS-IFB over EBUS-TBNA was observed in malignant conditions. These findings should be interpreted in the context of the study's selection bias, as EBUS-IFB was preferentially performed in patients with suspected benign or granulomatous disease.
OBJECTIVES: To compare the diagnostic yields of EBUS-TBNA and EBUS-IFB for the cytological and/or histological diagnosis of mediastinal and hilar lymphadenopathy.
STUDY DESIGN AND METHODS: A single-centre, retrospective, paired study was conducted at Hôpital Nord, Marseille (Assistance Publique-Hôpitaux de Marseille, AP-HM, Marseille, France) in patients who underwent EBUS-TBNA and EBUS-IFB performed during the same procedure on the same target lymph node for the diagnosis of mediastinal lymphadenopathy. Diagnostic yields of both sampling techniques were compared in patients for whom a definitive diagnosis was established after completion of the diagnostic work-up.
RESULTS: A total of 131 patient records were analysed. A definitive diagnosis was obtained in 101 patients after endoscopic sampling and additional investigations, predominantly malignancies (41 patients) and granulomatous diseases (54 patients). Endoscopic samples were considered adequate for interpretation in 103 patients (78%) with EBUS-IFB and in 114 patients (87%) with EBUS-TBNA. In 70 patients (69%), bronchoscopy alone provided a definitive diagnosis without the need for further investigations, 61 diagnoses were obtained by EBUS-IFB and 28 by EBUS-TBNA (p = 10⁻⁷). Among the 41 malignant cases, diagnoses were established in 22 patients using EBUS-IFB and in 25 patients using EBUS-TBNA. EBUS-IFB enabled the diagnosis of granulomatous disease in 39 patients, compared with only 3 patients using EBUS-TBNA (p = 10⁻⁵). Two procedures were complicated by minor bleeding.
CONCLUSION: In this retrospective, single-centre study, EBUS-IFB was associated with a higher diagnostic yield for mediastinal lymphadenopathy, with a significant benefit observed in selected patients with granulomatous diseases. No additional diagnostic benefit of EBUS-IFB over EBUS-TBNA was observed in malignant conditions. These findings should be interpreted in the context of the study's selection bias, as EBUS-IFB was preferentially performed in patients with suspected benign or granulomatous disease.