This prospective multicentre study compared the diagnostic yield of EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) versus EBUS-guided transbronchial needle aspiration (EBUS-TBNA) in 50 patients with suspected mediastinal lymphoproliferative disorders (LPDs), with final diagnoses confirmed at 6-month follow-up.
EBUS-TBMC achieved a significantly higher overall diagnostic yield than EBUS-TBNA (80% vs. 52%); for confirmed LPDs specifically, yields were 85% vs. 41%. Among cases non-diagnostic by EBUS-TBNA, 80% were successfully diagnosed by EBUS-TBMC (OR 4.89, 95% CI 1.76–13.6). No major complications were observed with EBUS-TBMC.
- Small sample size (n=50 analyzable patients) limits generalizability. - Eight cases of failed EBUS-TBMC were excluded from analysis, which may introduce selection bias and overestimate TBMC success rates. - All patients had B symptoms or a known LPD history, limiting applicability to unselected mediastinal lymphadenopathy populations.
In patients with suspected mediastinal LPDs, adding EBUS-TBMC after a non-diagnostic EBUS-TBNA can rescue diagnosis in 80% of those cases — consider EBUS-TBMC as the preferred or complementary sampling strategy in this setting. The absence of major complications supports its safety profile, though the 14% procedural failure rate warrants attention.
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