Enhancing diagnostic yield: The role of endobronchial ultrasound-guided cryobiopsy in the evaluation of mediastinal lymphadenopathy

Authors

• Nihar Shah, Department of Interventional Pulmonology, Inova Schar Cancer Institute, Inova Fairfax Hospital, Falls Church, VA.
• Roshen Mathew, Interventional Pulmonology Services, WVU Medicine Camden Clark Medical Center, Parkersburg, WV.
• Hasnain Bawaadam, Advocate Health - MidwestFollow
• Arthur Oliver Romero, Division of Pulmonary and Critical Care, Kerkorian School of Medicine at UNLV, Las Vegas, NV.
• Sushant Nanavati, Advocate Health - MidwestFollow
• Stephanie Baltaji, Department of Interventional Pulmonology, Allegheny Health Network, Pittsburgh, PA.
• Toribiong Uchel, Departments of Interventional Pulmonology, Virginia Commonwealth University, Richmond, VA.
• Wes Shepherd, Departments of Interventional Pulmonology, Virginia Commonwealth University, Richmond, VA.
• Jon Brandon Mullholand, Pulmonology and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA.
• Josh Boron, Internal Medicine, Virginia Commonwealth University, Richmond, VA.
• Elizabel Thomas, Department of Internal Medicine, WVU Medicine Camden Clarke Medical Center, Parkersburg, WV.
• Cliff Chen, Department of Pulmonology and Critical Care Medicine, University of Nevada, Las Vegas, NV.
• Danai Khemasuwan, Departments of Interventional Pulmonology, Virginia Commonwealth University, Richmond, VA.

Recommended Citation

Shah N, Mathew R, Bawaadam H, et al. Enhancing Diagnostic Yield: The Role of Endobronchial Ultrasound-Guided Cryobiopsy in the Evaluation of Mediastinal Lymphadenopathy. CHEST Pulm. 2026;4(3):100254. Published 2026 Mar 9. doi:10.1016/j.chpulm.2026.100254

Affiliations

Aurora Medical Center Kenosha

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for evaluating mediastinal lymphadenopathy, particularly in lung cancer diagnosis. However, its diagnostic effectiveness may be limited for conditions such as granulomatous disease and lymphoma, which often require preserved tissue architecture. Endobronchial ultrasound-guided mediastinal cryobiopsy (EBUS-MCB) is an emerging technique with promising diagnostic potential. This study evaluates the additive diagnostic yield of EBUS-MCB in patients with inconclusive or inadequate rapid on-site evaluation (ROSE) during EBUS-TBNA.

Research question: Does the addition of EBUS-MCB improve diagnostic yield in patients with inconclusive or absent ROSE during EBUS-TBNA, and is the technique safe in clinical practice?

Study design and methods: We conducted a retrospective multicenter study of patients with inconclusive or inadequate ROSE during EBUS-TBNA. EBUS-MCB was performed in addition to standard transbronchial needle aspiration sampling. Diagnostic yield and procedural complications were assessed.

Results: Among 145 patients, EBUS-MCB was performed after inconclusive ROSE. Most procedures were conducted under general anesthesia (98.6%), with endotracheal intubation in 71.7%. The mean lymph node diameter was 20.95 mm, with an average of 5.1 transbronchial needle aspiration passes and 3.6 cryobiopsy samples per node. EBUS-TBNA alone achieved a diagnostic yield of 91.7%, identifying 34 malignancies. EBUS-MCB detected 15 additional malignancies, increasing the total to 49 and raising overall diagnostic yield to 97.7%. EBUS-MCB also identified 25 additional granulomatous cases beyond the 29 detected by EBUS-TBNA. A definitive diagnosis of malignancy or granulomatous disease was established in 106 patients (73.1%). No major complications occurred; minor bleeding was managed conservatively.

Interpretation: Our results show that EBUS-MCB identified additional diagnoses of granulomatous disease and lymphoma in patients with inconclusive ROSE after EBUS-TBNA and appears to be a safe and effective adjunctive technique for enhancing diagnostic yield in mediastinal lymphadenopathy.

Document Type

Article

PubMed ID

42698836