Transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lymph nodes

J. Cascón Hernández*^a (Dr), M. Ariza Prota^a (Dr), F. López González^a (Dr), L. García Alfonso^a (Dr), M. Gil Muñiz^b (Mrs), I. Sánchez Fernández^b (Mrs), á. Lanza Martínez^c (Dr), C. De La Escosura Muñoz^c (Dr), L. Abad Chamorro^c (Dr), A. Fernández Fernández^c (Dr), LM. Fernández Fernández^d (Dr), H. Torres Rivas^d (Dr), M. García Clemente^c (Dr)

^a Interventional Pulmonology Unit. Pulmonology Department. Hospital Universitario Central de Asturias, Oviedo, SPAIN ; ^b Nurse. Interventional Pulmonoloy Unit. Hospital Universitario Central de Asturias, Oviedo, SPAIN ; ^c Pulmonology Department. Hospital Universitario Central de Asturias, Oviedo, SPAIN ; ^d Pathology Department. Hospital Universitario Central de Asturias, Oviedo, SPAIN

* jcasconh@gmail.com

BACKGROUND

Linear echobronchoscopy-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic yield in the diagnosis and staging of lung cancer. However, it is not as high in other diseases involving mediastinal lymphadenopathy, such as lymphoproliferative syndromes or granulomatous diseases. Mediastinal cryobiopsy could help to improve this performance.

METHODS

• A prospective study was conducted.
• From march to June 2022, we consecutively included all patients who underwent linear echobronchoscopy-guided transbronchial mediastinal cryobiopsy (EBUS-TMC).
• Once EBUS-TBNA was performed, a 1.1 mm cryoprobe (Erbe) was introduced into the lymph node (LN) to perform EBUS-TMC.
• Data collected: Anthropometric data, size and location of LN, size and results of samples, diagnosis, complications.
• Results are expressed as mean (and range), relative frequencies.

RESULTS

• A total of 32 LN in 26 patients were included. 65% of them were male with an age of 62.6 (34-85) years.
• EBUS-TMC samples were representative in 94%. In 3 of them (9%) added relevant information not provided by EBUS-TBNA: determined the histologic subtype (2 cases) or was the only positive sample (1).
• The biopsied LN measured 23.8 (10-48) mm by EBUS and were located in the following regions: 7 in 47% (15/32), 11L in 25% (8/32), 11Ri in 6% (2/32), 4L in 6% (2/32), 4R in 6% (2/32), 2R in 3% (1/32), 3p in 3% (1/32) and right lower lobe in 3% (1/32).
• Cryobiopsy samples measured 0.4 (0.1-0.7) cm.
• The list of definitive diagnoses included: adenocarcinoma in 27% (7/26), sarcoidosis in 19% (5/26), squamous cell carcinoma in 15% (4/26), small cell carcinoma in 12% (3/26), Negative-Anthracosis in 12% (3/26), follicular B lymphoma in 8% (2/26), NSCLC in 4% (1/26), Breast cancer metastasis in 4% (1/26).
• There were no complications.

CONCLUSIONS

1. EBUS-TMC is a safe technique that can be performed in all EBUS regions.

2. Mediastinal cryobiopsy provides relevant information that complements EBUS-TBNA.

Disclosure of funding source(s): none