Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for staging and diagnosing non-small cell lung cancer due to its safety and accuracy. But it has important limitations, including inadequate tissue sampling, reduced utility in lymphoproliferative and granulomatous disorders, and low accuracy in lymphoma subtyping. Surgical biopsy, especially mediastinoscopy, remains the gold standard for suspected lymphoma; however, it is invasive and carries a higher risk, mainly in relapsed cases. A meta-analysis reported that EBUS-TBNA has a specificity of 99.3% but a sensitivity of only 66.2% for lymphoma. Recently, endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) has emerged as a technique that provides higher-quality and larger samples for improving diagnostic yield. A study published in ERJ Open Research compared the sensitivity of EBUS-TMC and EBUS-TBNA in newly diagnosed and recurrent lymphoma.
In this multi-centre retrospective observation study, a total of 40 patients (median age = 58 [23-87] years, male = 47.5%, female = 52.5%) were included. In the same surgical procedure, all these included patients underwent both EBUS-TMC and EBUS-TBNA, and all received a definitive lymphoma diagnosis. The study period spanned from January 2023 to January 2024. All patients underwent both EBUS-TMC and EBUS-TBNA on the same lymph node, using mainly 22G needles (87.5%), with an average of three passes per procedure. Cryobiopsies were obtained using the Ariza-Pallares method with a 1.1 mm cryoprobe. Samples were processed for flow cytometry, histopathology, and immunohistochemistry. Data analysis was performed using ANOVA, t-test, and Chi-square test through Stata v15.1 (StataCorp).
Of the 40 cases, 65% were new lymphoma diagnoses, whereas 35% were recurrences. The majority of lymph nodes measured were greater than 10 mm, with the most common locations being stations 4R (23%) and 7 (53%). Flow cytometry was carried out in 83% of cases (n = 33). EBUS-TMC demonstrated significantly higher overall sensitivity compared to both EBUS-TBNA alone and EBUS-TBNA combined with flow cytometry, with rates of 95%, 15%, and 25%, respectively. In newly diagnosed lymphoma cases, EBUS-TMC sensitivity reached 92% compared with EBUS-TBNA (15%) and EBUS-TBNA plus flow cytometry (14%). For recurrent lymphoma, EBUS-TMC achieved 100% sensitivity, whereas EBUS-TBNA yielded 14% and EBUS-TBNA+flow cytometry yielded 41%. The procedures were safe with no complications reported in any of the patients.
This study’s limitations include its retrospective design and incomplete immunophenotyping in 17.5% of cases, which may have underestimated the sensitivity of EBUS-TBNA. There is a need for larger, prospective multicentre studies with standardized methods to confirm the generalizability and validity of these findings.
This study concluded that EBUS-TMC is a highly effective diagnostic tool for both new and recurrent mediastinal lymphomas. It is safer, less invasive, and potentially more cost-effective compared to mediastinoscopy. These findings support EBUS-TMC as a promising primary diagnostic approach for mediastinal lymphoproliferative disorders. Further studies are needed to evaluate its economic impact.
Reference: Ariza-Prota M, PĂ©rez-PallarĂ©s J, Barisione E, et al. Enhancing diagnostic precision: a multicentric study of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in lymphoproliferative disorders. ERJ Open Res. 2025;11(5):00775-2024. doi:10.1183/23120541.00775-2024          Â
