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Observational Study
. 2025 Oct:247:108294.
doi: 10.1016/j.rmed.2025.108294. Epub 2025 Aug 6.

Diagnostic performance and safety of endobronchial ultrasound-guided transbronchial cryobiopsies in the diagnosis of mediastinal lesions

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Free article
Observational Study

Diagnostic performance and safety of endobronchial ultrasound-guided transbronchial cryobiopsies in the diagnosis of mediastinal lesions

Sabina Perelló Roselló et al. Respir Med. 2025 Oct.
Free article

Abstract

Background: Endobronchial ultrasound-guided transbronchial cryobiopsy (Cryo-EBUS) is an emerging technique for diagnosing mediastinal lesions, offering larger and better-preserved tissue samples compared to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). However, its diagnostic performance, safety, and role in clinical practice remain under investigation.

Methods: We conducted a prospective observational study including 100 consecutive patients with mediastinal/hilar lymphadenopathies or masses who underwent both Cryo-EBUS and EBUS-TBNA in the same procedure. The diagnostic yields, their ability to provide adequate tissue for molecular testing, safety outcomes, and the learning curve were analyzed.

Results: Cryo-EBUS demonstrated a significantly higher diagnostic yield (80 %, 95 %CI:72-88 %) compared to EBUS-TBNA (72 %, 95 %CI:63-81 %), with a further increase when both techniques were combined, especially in cancer lesions (93.3 %, 95 %CI:87.6-99.1 %). The technique was particularly effective in PET-CT positive lesions. Additionally, Cryo-EBUS provided high-quality tissue samples, allowing biomarker analysis in 91 % of cases. A learning curve effect was observed, with diagnostic yield improving from 53 % in the first 15 cases to 84.7 % thereafter (p = 0.001). Cryo-EBUS had a favorable safety profile, with only three minor complications (pneumothorax and pneumomediastinum), all conservatively resolved.

Conclusion: Cryo-EBUS is a safe and effective technique for mediastinal lesion diagnosis, particularly when combined with EBUS-TBNA. It enhances diagnostic accuracy, improves molecular testing capabilities, and remains minimally invasive. The integration of PET findings may further optimize its application. Standardized protocols are needed to refine its clinical use and establish its role in routine practice.

Keywords: Cryoprobe; EBUS-Guided cryobiopsy; Endobronchial ultrasound; Interventional bronchoscopy; Interventional pulmonology; Lung cancer.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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