Diagnostic Yield of CE-EBUS in Mediastinal and Hilar Lymphadenopathy: A Preliminary Study

<b>Background/Objectives</b>: Contrast-enhanced endobronchial ultrasound (CE-EBUS) is a minimally invasive technique that combines traditional endobronchial ultrasound (EBUS) with a contrast agent (sulfur hexafluoride), enhancing the visualization of blood flow in mediastinal and hilar lymph nodes. This study aimed to assess the use of CE-EBUS in patients with advanced neoplasms and hilar or mediastinal lymphadenopathy, particularly to improve diagnostic accuracy and expedite sample collection. <b>Methods</b>: A retrospective observational study was conducted from April 2021 to December 2023, involving 49 patients divided into two groups: EBUS (<i>n</i> = 26) and CE-EBUS (<i>n</i> = 23). Patients had advanced neoplasms with hilar and mediastinal lymphadenopathy, including bulky masses and nodal metastases with central necrosis. In the CE-EBUS group, 4.8 mL of sulfur hexafluoride was administered intravenously. Morphological, echogenic, and vascular characteristics, diagnostic accuracy, sample collection adequacy and molecular testing were compared between the groups. <b>Results</b>: The diagnostic accuracy in CE-EBUS was similar to EBUS (21 vs. 19 patients), with no significant difference (<i>p</i> = 0.100). However, for patients with bulky masses and necrosis, the molecular assessment rate was significantly higher in the CE-EBUS group (81.8%) compared to the EBUS group (33.3%) (<i>p</i> = 0.014). <b>Conclusions</b>: CE-EBUS-TBNA could improve the accuracy of molecular assessments in patients with bulky, necrotic lymphadenopathy and could help collect vital neoplastic tissue for molecular testing.