The role of Cryo-EBUS in the diagnosis of mediastinal granulomatous diseases – A single centre experience

Background: Mediastinal lymphadenopathy due to benign and malignant aetiologies is commonly encountered in clinical practice.Mediastinoscopy has long been replaced by endobronchialultrasonography-guided transbronchial fine needle aspiration (EBUS-TBNA) as the procedure of choice in evaluating mediastinal pathologies.However, in benign mediastinal lymphadenopathy and lymphoma,diagnostic yield of EBUS-TBNA is low.This study evaluates the role of Cryobiopsy with EBUS (Cryo-EBUS) to enhance diagnostic accuracy for isolated intrathoracic lymphadenopathy in non-neoplastic granulomatous diseases like sarcoidosis and tuberculosis. Methods:In this retrospective analysis conducted at a single centre, 30 patients who underwent both EBUS-TBNA and Cryo-EBUS and were subsequently diagnosed with a granulomatous mediastinal lymphadenopathy were included.Sample adequacy, diagnostic yield, and safety profiles were compared between the two arms.Results: Cryo-EBUS demonstrated superior pathologic diagnostic yield (93.33% vs. 83.33%) in diagnosing granulomatous mediastinal lymphadenopathy.It had a higher overall diagnostic yield for sarcoidosis (100% vs. 84.21%).For tuberculosis, conventional EBUS-TBNA had a higher overall diagnostic yield (100% vs. 81.82%),attributable to the TBNA sample being sent for microbiological analysis.Combining both techniques resulted in an overall diagnostic yield of 100%, indicating Cryo-EBUS's complementary role in this patient cohort. Conclusions:This study highlights Cryo-EBUS as a promising diagnostic tool for intrathoracic lymphadenopathy, particularly in granulomatous diseases.Integrating Cryo-EBUS along with EBUS-TBNA in appropriate cases could enhance diagnostic outcomes, reduce repeat procedures, and support precision medicine in pulmonology.Further studies are needed to establish the role of Cryo-EBUS in this patient population.