Diagnostic Yield of EBUS Mediastinal Cryobiopsy Versus TBNA in Suspected Lymphoproliferative Disorders: A Prospective Multicentre Study.

BACKGROUND AND

OBJECTIVES

The diagnosis of mediastinal lymphoproliferative disorders (LPDs) is often challenging and requires histopathological assessment from large tissue samples. As a result, new diagnostic techniques have been introduced alongside the commonly used endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA). Among them, EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) has shown promising potential, although high-quality evidence remains limited. The aim of the study was to assess the diagnostic yield of EBUS-TBMC compared with EBUS-TBNA in patients with suspected mediastinal LPDs.

METHODS

This prospective multicentre study enrolled patients with suspected mediastinal LPDs undergoing bronchoscopy with EBUS for mediastinal lymph node sampling. All participants had either B symptoms or a history of LPD. All patients underwent EBUS-TBNA followed by EBUS-TBMC from the same mediastinal lymph node. Final diagnoses were confirmed after a 6-month follow-up.

RESULTS

Fifty-eight patients underwent EBUS, of whom 50 completed both EBUS-TBNA and EBUS-TBMC. There were eight cases of failed EBUS-TBMC who were not included in the analysis. The most frequent diagnoses were LPDs (54%) and sarcoidosis (30%). EBUS-TBNA and EBUS-TBMC had overall diagnostic yield of 52% and 80%, respectively. Among non-diagnostic EBUS-TBNA samples, 80% were diagnostic with EBUS-TBMC (odds ratio 4.89, 95% CI 1.76-13.6). For confirmed LPDs, diagnostic yield was 41% for EBUS-TBNA and 85% for EBUS-TBMC. No major complications during or following the EBUS-TBMC were observed.

CONCLUSION

EBUS-TBMC was superior to EBUS-TBNA and achieved a high diagnostic yield in patients with suspected mediastinal LPDs.