Enhancing diagnostic precision: a multicentric study of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in lymphoproliferative disorders

Abstract

BACKGROUND: The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of lymphoma has a low overall sensitivity. The lack of tissue architecture obtained by cytological needles decreases the diagnostic accuracy for diagnosis and subtyping of de novo and relapsed mediastinal lymphomas. This study compares the sensitivity of EBUS-TBNA and endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) for both initial lymphoma diagnosis and recurrent cases, analyses safety, and evaluates the number of mediastinoscopies that could potentially be avoided due to this novel technique. METHODS: A multicentre retrospective observational study conducted on 40 patients who underwent both EBUS-TBNA and EBUS-TMC in the same procedure in which a definitive diagnosis of lymphoma was obtained from January 2023 to January 2024. EBUS-TBNA and EBUS-TMC were performed in the same lymph node station. RESULTS: The overall sensitivity of EBUS-TMC was significantly higher compared to EBUS-TBNA alone and EBUS-TBNA+flow cytometry (95% versus 15% versus 25%). In new lymphoma cases, the sensitivity of EBUS-TMC surpassed that of EBUS-TBNA and EBUS-TBNA+flow cytometry (92% versus 15% versus 14%). In recurrent cases, EBUS-TMC showed a sensitivity of 100%, while EBUS-TBNA and EBUS-TBNA+flow cytometry had lower yields of 14% and 41%, respectively. No complications were reported. CONCLUSIONS: EBUS-TMC demonstrates superior sensitivity compared to EBUS-TBNA in diagnosing and subtyping lymphoma, both in suspected new cases and recurrences. This technique reduces the need for procedural repetitions and avoids more invasive and costly interventions such as mediastinoscopy.