Endobronchial Ultrasound-guided Mediastinal Lymph Nodal Cryobiopsy in Patients With Nondiagnostic/Inadequate Rapid On-site Evaluation

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered the investigation of choice for sampling mediastinal nodes. A major drawback of EBUS-TBNA is its lower diagnostic yield for lymphoma and benign diseases. EBUS-guided mediastinal cryobiopsy (EBUS-MCB) is a novel technique that provides larger nodal biopsy samples, with an acceptable safety profile. In this study, we aimed to evaluate the diagnostic yield of EBUS-MCB in patients with an inconclusive rapid on-site evaluation (ROSE).Methods: This is a prospective study of patients who underwent EBUS-TBNA for undiagnosed mediastinal lymphadenopathy. Patients in whom ROSE did not yield a diagnosis (nondiagnostic ROSE) or ROSE revealed scanty atypical cells (inadequate ROSE) were subjected to EBUS-MCB. The diagnostic yield, adequacy, and complications of EBUS-MCB were analyzed.Results: Of the 196 patients undergoing EBUS-TBNA, 46 patients underwent EBUS-MCB. Thirty-two cases underwent EBUS-MCB for a nondiagnostic ROSE. EBUS-MCB confirmed the diagnosis in 19/32 (59.3%) cases. The additive diagnostic yield of EBUS-MCB over EBUS-TBNA was 43.7% (14/32 cases). In all 14 cases where EBUS-MCB was performed for an inadequate ROSE, the material obtained by EBUS-MCB was adequate for ancillary studies. The most common complication observed was a minor bleed in 13 cases.Conclusion: EBUS-MCB has a diagnostic yield of 59.3% when performed in cases with a nondiagnostic EBUS-ROSE. The tissue obtained by EBUS-MCB is adequate for ancillary studies. We propose EBUS-MCB as an additional diagnostic step in cases with an inconclusive ROSE while performing EBUS-TBNA. Larger studies are, however, needed before EBUS-MCB can be incorporated in the diagnostic algorithm for the evaluation of mediastinal lesions.

Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: a narrative review

“…In Maturu et al ( 12 ), EBUS-TMC confirmed diagnoses in 33 cases (71.7%). In 14 cases with inadequate ROSE that subsequently underwent EBUS-TMC, malignancy was confirmed by both EBUS-TMC and EBUS-TBNA.…”

“…Ariza-Prota et al ( 11 ) conducted a prospective study in Spain on 50 patients, wherein participants underwent EBUS-TBNA followed by EBUS-TMC. Maturu et al ( 12 ) carried out a prospective study on 46 patients in India, in which EBUS-TMC was conducted if rapid on-site evaluation (ROSE) during EBUS-TBNA yielded insufficient or inconclusive results. A prospective study in Israel documented EBUS-TMC in 24 patients ( 13 ) and two case reviews have been conducted, one on four patients ( 14 ) and one on five patients ( 15 ).…”

What is new in mediastinal staging?

“…Endobronchial ultrasound-guided transbronchial lymph node cryobiopsy (EBUS-TBLCB) involves a similar technique as EBUS-IFB where a hole is first created in the airway for advancement of the cryoprobe. Multiple tools have been reported for this purpose, including needles with various gauges, electrocautery knife and Nd YAG Laser [60 ▪ ,61 ▪▪ ,62,63,64 ▪▪ ,65]. After freezing, the cryoprobe and EBUS scope are removed in block for specimen retrieval (Fig.…”

“…Maturu et al . [64 ▪▪ ] performed EBUS-TBLCB when ROSE was nondiagnostic or inconclusive. The additive diagnostic yield of cryobiopsy was 43.7% in 32 patients with nondiagnostic ROSE and cryobiopsy was the only diagnostic modality in 14 patients with primarily nonmalignant conditions, like prior studies [64 ▪▪ ].…”

“…[64 ▪▪ ] performed EBUS-TBLCB when ROSE was nondiagnostic or inconclusive. The additive diagnostic yield of cryobiopsy was 43.7% in 32 patients with nondiagnostic ROSE and cryobiopsy was the only diagnostic modality in 14 patients with primarily nonmalignant conditions, like prior studies [64 ▪▪ ]. Whereas the results of this study are not applicable to centres without ROSE capability, it highlights a potential algorithm for incorporating EBUS-TBLCB into the evaluation of mediastinal lesions.…”