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. 2025 Apr 18;14(8):2800.
doi: 10.3390/jcm14082800.

Diagnostic Yield of CE-EBUS in Mediastinal and Hilar Lymphadenopathy: A Preliminary Study

Ilaria Suriano  1 , Luca Frasca  1   2 , Filippo Longo  1 , Antonio Sarubbi  1   3 , Giovanni Tacchi  1 , Pierfilippo Crucitti  1
Affiliations

Diagnostic Yield of CE-EBUS in Mediastinal and Hilar Lymphadenopathy: A Preliminary Study

Ilaria Suriano et al. J Clin Med. .

Abstract

Background/Objectives: Contrast-enhanced endobronchial ultrasound (CE-EBUS) is a minimally invasive technique that combines traditional endobronchial ultrasound (EBUS) with a contrast agent (sulfur hexafluoride), enhancing the visualization of blood flow in mediastinal and hilar lymph nodes. This study aimed to assess the use of CE-EBUS in patients with advanced neoplasms and hilar or mediastinal lymphadenopathy, particularly to improve diagnostic accuracy and expedite sample collection. Methods: A retrospective observational study was conducted from April 2021 to December 2023, involving 49 patients divided into two groups: EBUS (n = 26) and CE-EBUS (n = 23). Patients had advanced neoplasms with hilar and mediastinal lymphadenopathy, including bulky masses and nodal metastases with central necrosis. In the CE-EBUS group, 4.8 mL of sulfur hexafluoride was administered intravenously. Morphological, echogenic, and vascular characteristics, diagnostic accuracy, sample collection adequacy and molecular testing were compared between the groups. Results: The diagnostic accuracy in CE-EBUS was similar to EBUS (21 vs. 19 patients), with no significant difference (p = 0.100). However, for patients with bulky masses and necrosis, the molecular assessment rate was significantly higher in the CE-EBUS group (81.8%) compared to the EBUS group (33.3%) (p = 0.014). Conclusions: CE-EBUS-TBNA could improve the accuracy of molecular assessments in patients with bulky, necrotic lymphadenopathy and could help collect vital neoplastic tissue for molecular testing.

Keywords: CE-EBUS; EBUS; lung cancer; mediastinal staging; sulfur hexafluoride.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of diagnostic and nondiagnostic biopsies in the CE-EBUS and EBUS groups.
Figure 2
Figure 2
Contrast-enhanced EBUS-TBNA in mediastinal lymphadenopathy. Malignant bulky mediastinal lymph node. After 16–17 s post contrast injection, significant enhancement of the vascular pattern is evident (yellow arrow). The biopsy was performed avoiding non-enhanced areas indicative of necrosis. The left image shows a strip of hyperechoic tissue, corresponding to the vital tissue area where the biopsy was performed. In contrast, the B-mode image on the right does not clearly reveal this area.
See this image and copyright information in PMC

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