ArticleCHEST pulmonary2026
Enhancing Diagnostic Yield: The Role of Endobronchial Ultrasound-Guided Cryobiopsy in the Evaluation of Mediastinal Lymphadenopathy.
Article in CHEST pulmonary, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for evaluating mediastinal lymphadenopathy, particularly in lung cancer diagnosis. However, its diagnostic effectiveness may be limited for conditions such as granulomatous disease and lymphoma, which often require preserved tissue architecture. Endobronchial ultrasound-guided mediastinal cryobiopsy (EBUS-MCB) is an emerging technique with promising diagnostic potential. This study evaluates the additive diagnostic yield of EBUS-MCB in patients with inconclusive or inadequate rapid on-site evaluation (ROSE) during EBUS-TBNA. Research Question: Does the addition of EBUS-MCB improve diagnostic yield in patients with inconclusive or absent ROSE during EBUS-TBNA, and is the technique safe in clinical practice? Study Design and Methods: We conducted a retrospective multicenter study of patients with inconclusive or inadequate ROSE during EBUS-TBNA. EBUS-MCB was performed in addition to standard transbronchial needle aspiration sampling. Diagnostic yield and procedural complications were assessed. Results: Among 145 patients, EBUS-MCB was performed after inconclusive ROSE. Most procedures were conducted under general anesthesia (98.6%), with endotracheal intubation in 71.7%. The mean lymph node diameter was 20.95 mm, with an average of 5.1 transbronchial needle aspiration passes and 3.6 cryobiopsy samples per node. EBUS-TBNA alone achieved a diagnostic yield of 91.7%, identifying 34 malignancies. EBUS-MCB detected 15 additional malignancies, increasing the total to 49 and raising overall diagnostic yield to 97.7%. EBUS-MCB also identified 25 additional granulomatous cases beyond the 29 detected by EBUS-TBNA. A definitive diagnosis of malignancy or granulomatous disease was established in 106 patients (73.1%). No major complications occurred; minor bleeding was managed conservatively. Interpretation: Our results show that EBUS-MCB identified additional diagnoses of granulomatous disease and lymphoma in patients with inconclusive ROSE after EBUS-TBNA and appears to be a safe and effective adjunctive technique for enhancing diagnostic yield in mediastinal lymphadenopathy.
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