Cryobiopsy Outperforms Fine-Needle Aspiration for Mediastinal Lymphadenopathy: A Within-Patient Diagnostic Accuracy Study and Clinical Predictors of Success.

Background/

Objectives

Accurate diagnosis of lymph node pathology is essential for the management of both malignant and benign diseases. This study compares the diagnostic performance of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a real-world cohort.

Methods

A single-center retrospective observational study was conducted, including 91 patients who underwent both cryobiopsy and EBUS-TBNA for lymph node evaluation. EBUS-TBNA was performed with a 19-G needle and cryobiopsy with a 1.1 mm flexible cryoprobe. Clinical characteristics, positron emission tomography-computed tomography (PET-CT) findings, ultrasonographic characteristics of the lymph nodes, diagnostic yield, and procedure-related complications were analyzed. Diagnostic accuracy, sensitivity, specificity, and factors associated with correct diagnosis were assessed.

Results

The median age of the cohort was 65 years [interquartile range-IQR-56-74], 63.7% were male, and 74.7% were former or current smokers. Malignant disease was ultimately diagnosed in 60 patients (65.9%), of whom 78.3% had non-lymphoproliferative tumours and 21.7% had lymphoproliferative malignancies. The diagnostic accuracy of cryobiopsy was 89%, compared with 82.4% for EBUS-TBNA. The paired comparison between the two techniques did not reach statistical significance. After exclusion of non-diagnostic samples, sensitivity was numerically higher for cryobiopsy (96.4%, 95% CI 90.7-100) than for EBUS-TBNA (88.9%, 95% CI 79.6-98.2). Factors associated with correct diagnosis included chronic obstructive pulmonary disease for cryobiopsy, cardiovascular comorbidities, and maximum SUV for EBUS-TBNA. In malignant lesions, cryobiopsy showed higher diagnostic accuracy than EBUS-TBNA (90% vs. 80% accuracy), particularly in lymphoproliferative diseases. In benign lesions, both techniques agreed in 17 (54%) of cases, with cryobiopsy showing a higher yield for sarcoidosis and contributing to the diagnosis of tuberculosis. Complications were infrequent and minor, with no major adverse events reported.

Conclusions

Cryobiopsy showed numerically higher diagnostic accuracy and sensitivity compared with EBUS-TBNA, particularly in malignant and lymphoproliferative disorders, with a favorable safety profile. These findings support its role as a valuable complement-or alternative-to conventional EBUS-TBNA in the assessment of mediastinal lymph nodes.