Clinical performance of EBUS-guided mediastinal lymph node cryobiopsy versus EBUS-TBNA for diagnosing mediastinal lymphadenopathy: Results from the largest single centre observational study over 4 years.

BACKGROUND

While EBUS-TBNA is the first-line modality for sampling mediastinal lymphadenopathy, its diagnostic yield is variable, and sample often inadequate for advanced molecular testing. EBUS-guided mediastinal cryobiopsy (EBUS-MCB) enables acquisition of larger, intact tissue specimens. This study assesses the diagnostic yield and safety of EBUS-MCB in cases with inconclusive smear, or atypical cells on rapid on-site evaluation (ROSE).

METHODS

We retrospectively analysed patients who underwent EBUS-MCB between March 2022 and August 2025. EBUS-MCB was performed in cases with a non-diagnostic ROSE or atypical cells on ROSE following EBUS-TBNA. EBUS-MCB was performed using a 1.1 mm cryoprobe through a needle-created tract under real-time EBUS guidance. Diagnostic yield, tissue adequacy, final diagnoses, and complications were recorded.

RESULTS

A total of 251 patients (mean age 52.5 years; 58.6% male) underwent EBUS-MCB. The most frequently sampled nodal stations were 7(n = 106) and 4R(n = 67). Tracts were created using 21G needles(n = 129),19G needles(n = 109) and 22G needles(n = 13). Diagnoses included malignancies(n = 100), granulomatous diseases(n = 84) and reactive nodes(n = 63). Diagnostic yield of EBUS-MCB was significantly higher than EBUS-TBNA (74.5% vs 49.8%; p < 0.005). Among inconclusive ROSE cases, EBUS-MCB had a diagnostic yield of 61.8% versus 27.3% with TBNA (p < 0.005). An additive diagnostic yield of 47.5% was observed with EBUS-MCB when final TBNA was non diagnostic. Mild and moderate bleeding occurred in 32.6% and 2.4% cases, respectively. No major complications were observed.

CONCLUSION

EBUS-MCB is a safe and valuable adjunct to EBUS-TBNA, significantly improving diagnostic yield in ROSE-inconclusive cases. Its integration could reduce the need for invasive surgical procedures in evaluating mediastinal lymphadenopathy.