The evolving role of interventional pulmonology with endobronchial ultrasonography in the diagnosis of lymphoma: a narrative review.

BACKGROUND AND

OBJECTIVE

For patients undergoing evaluation for mediastinal/hilar adenopathy or masses suspicious for lymphoma, endobronchial ultrasonography (EBUS)-transbronchial needle aspiration (TBNA) offers a lower-risk alternative to surgical or percutaneous biopsy. While the utility of EBUS-TBNA is well established in lung cancer diagnosis, including biomarker analysis, its role in lymphoma is more limited. This is because for accurate subtyping of lymphoma, larger intact tissue specimens are needed and EBUS-TBNA can only provide cytology specimens. To address this limit, various needle sizes and/or sampling techniques such as cryobiopsy have been investigated to improve diagnostic sensitivity for lymphoma. In this review, we discuss the current evidence for these various techniques in the diagnosis of lymphoma.

METHODS

We conducted a narrative review by searching PubMed/MEDLINE, Embase and Google Scholar for articles published during 1980-2025 using search terms including "EBUS", "EBUS-TBNA", "endobronchial ultrasound", "bronchoscopy", "lymphoma diagnosis", "mediastinal lymphadenopathy" and "interventional pulmonology". Only articles written in English that focused on evaluation of diagnostic sensitivity, specimen adequacy, and interventional techniques for suspected lymphoma were included in our review.

KEY CONTENT AND FINDINGS: Several studies suggested that EBUS-TBNA combined with appropriate immunohistochemical, flow cytometry, cytogenetic, and molecular studies can achieve an accurate lymphoma diagnosis. However, its sensitivity for de novo lymphoma remains modest. Various techniques such as cryobiopsy, bigger needles, and forceps via EBUS may improve tissue acquisition but whether this translates into improved diagnostic yield is uncertain.

CONCLUSIONS

For patients undergoing evaluation for mediastinal/hilar adenopathy or masses suspicious for lymphoma, EBUS with TBNA, or with other techniques such as cryobiopsy, may be a reasonable first diagnostic step, as it is less invasive with a better safety profile than surgical excision of these lymph nodes. Prospective studies are needed to establish best practices for the use of EBUS to diagnose lymphoma.