Diagnostic Yield of <scp>EBUS</scp> Mediastinal Cryobiopsy Versus <scp>TBNA</scp> in Suspected Lymphoproliferative Disorders: A Prospective Multicentre Study

BACKGROUND AND OBJECTIVES: The diagnosis of mediastinal lymphoproliferative disorders (LPDs) is often challenging and requires histopathological assessment from large tissue samples. As a result, new diagnostic techniques have been introduced alongside the commonly used endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA). Among them, EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) has shown promising potential, although high-quality evidence remains limited. The aim of the study was to assess the diagnostic yield of EBUS-TBMC compared with EBUS-TBNA in patients with suspected mediastinal LPDs. METHODS: This prospective multicentre study enrolled patients with suspected mediastinal LPDs undergoing bronchoscopy with EBUS for mediastinal lymph node sampling. All participants had either B symptoms or a history of LPD. All patients underwent EBUS-TBNA followed by EBUS-TBMC from the same mediastinal lymph node. Final diagnoses were confirmed after a 6-month follow-up. RESULTS: Fifty-eight patients underwent EBUS, of whom 50 completed both EBUS-TBNA and EBUS-TBMC. There were eight cases of failed EBUS-TBMC who were not included in the analysis. The most frequent diagnoses were LPDs (54%) and sarcoidosis (30%). EBUS-TBNA and EBUS-TBMC had overall diagnostic yield of 52% and 80%, respectively. Among non-diagnostic EBUS-TBNA samples, 80% were diagnostic with EBUS-TBMC (odds ratio 4.89, 95% CI 1.76-13.6). For confirmed LPDs, diagnostic yield was 41% for EBUS-TBNA and 85% for EBUS-TBMC. No major complications during or following the EBUS-TBMC were observed. CONCLUSION: EBUS-TBMC was superior to EBUS-TBNA and achieved a high diagnostic yield in patients with suspected mediastinal LPDs.