Spectrum of Diagnoses and Sonographic Lymph Node Characteristics in Patients Undergoing EBUS-FNA for Undiagnosed Mediastinal Lymphadenopathy at a Tertiary Care Teaching Hospital in North India

Background: Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) is the cornerstone for minimally invasive evaluation of mediastinal lymphadenopathy.Data from tuberculosis (TB)-endemic regions describing both diagnostic outcomes and sonographic lymph node (LN) characteristics remain limited.Methods: We retrospectively analyzed 207 consecutive patients who underwent EBUS-FNA for undiagnosed mediastinal lymphadenopathy between January 2021 and January 2025 at a tertiary care teaching hospital in North India.Patients with known malignancy undergoing staging were excluded.Demographic, procedural, sonographic, and cytopathologic variables were evaluated.Results: Among 207 patients (67% male; age range 14-82 years), 84% had comorbidities and 75% were smokers.Endobronchial ultrasound identified 748 LNs, most frequently at stations 7, 10R, 4R, 4L, and 10L.A median of four passes per node was performed.A definitive diagnosis was achieved in 91.3%: TB 52% (97% drug-sensitive, 3% drug-resistant on GeneXpert), sarcoidosis 29%, malignancy 12% (mainly adenocarcinoma and squamous-cell carcinoma), reactive lymphoid hyperplasia 4%, and others 3%.Diagnostic yield was comparable across 19G, 21G, and 22G needles.Minor self-limiting complications occurred in 10% of cases, with no major adverse events reported.Conclusion: Endobronchial ultrasound-guided fine-needle aspiration under general anesthesia (GA) provided consistently high diagnostic yield with an excellent safety profile.Incorporating sonographic parameters such as shape, echotexture, and the presence or absence of central hilar or necrotic features helps refine LN selection and enhances diagnostic precision.