Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: a narrative review

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Abstract

Background and Objective

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe, and well-established method for diagnosing and staging lung cancer and other conditions associated with mediastinal lymphadenopathy. Efforts have been made to enhance the material adequacy of EBUS-TBNA, including the recent introduction of EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TMC). This advancement facilitates the acquisition of larger and better-preserved tissue samples from the mediastinum. We evaluated the diagnostic accuracy and safety of EBUS-TMC in the diagnosis of malignant lesions and its effectiveness in relation to benign conditions, such as tuberculosis and sarcoidosis.

Methods

We searched the PubMed ^® database for relevant English articles published up to July 1, 2023. Subsequently, we conducted a comprehensive bibliographic analysis with a particular emphasis on diagnostic yield, safety profile, and procedural technicalities.

Key Content and Findings

Our narrative review, comprising seven publications, emphasizes the significance of EBUS-TMC as an effective technique for obtaining diagnostic tissue in malignant and benign conditions while maintaining an excellent safety profile. Furthermore, its capability for obtaining larger tissue samples facilitates molecular and immunological analysis in non-small cell lung cancer.

Conclusions

EBUS-TMC exhibits significant efficacy with regard to obtaining diagnostic tissue in malignant and benign conditions. However, further studies are needed to evaluate uncertainties regarding the selection of suitable cases and technical intricacies.

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Most cited references 15

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British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults.

I Du Rand, P V Barber, J. Goldring … (2011)

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Transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: a randomised trial

Jing Zhang, Jie-Ru Guo, Zan-Sheng Huang … (2021)

Background Guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as an initial investigatory technique for mediastinal nodal staging in lung cancer. However, EBUS-TBNA can be limited by the inadequacy of intact tissues, which might restrict its diagnostic yield in mediastinal lesions of certain aetiologies. We have previously shown that EBUS-guided transbronchial mediastinal cryobiopsy can provide intact samples with greater volume. Methods This randomised study determined the diagnostic yield and safety of transbronchial mediastinal cryobiopsy monitored by endosonography for the diagnosis of mediastinal lesions. Patients with a mediastinal lesion of ≥1 cm in the short axis were recruited. Following identification of the mediastinal lesion by linear EBUS, fine-needle aspiration and cryobiopsy were sequentially performed in a randomised order. Primary end-points were diagnostic yield, defined as the percentage of patients for whom mediastinal biopsy provided a definite diagnosis, and procedure-related adverse events. Results In total, 197 patients were enrolled and randomly allocated. The overall diagnostic yield was 79.9% and 91.8% for TBNA and transbronchial mediastinal cryobiopsy, respectively (p=0.001). Diagnostic yields were similar for metastatic lymphadenopathy (94.1% versus 95.6%, p=0.58), while cryobiopsy was more sensitive than TBNA in uncommon tumours (91.7% versus 25.0%, p=0.001) and benign disorders (80.9% versus 53.2%, p=0.004). No significant differences in diagnostic yield were detected between “TBNA first” and “Cryobiopsy first” groups. We observed two cases of pneumothorax and one case of pneumomediastinum. Conclusions Transbronchial cryobiopsy performed under EBUS guidance is a safe and useful approach that offers diagnostic histological samples of mediastinal lesions.

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Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis of sarcoidosis in clinically unselected study populations.

Rocco Trisolini, Luigi Lazzari Agli, Carmine Tinelli … (2015)

Literature suggests that ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has excellent performance characteristics for diagnosis of sarcoidosis. However, many authors challenge the external validity of EBUS-TBNA results, as most studies were performed in referral centres by highly experienced investigators, and included populations with very high sarcoidosis prevalence. We performed a systematic review and meta-analysis to estimate the role of EBUS-TBNA for diagnosis of sarcoidosis in studies enrolling consecutive patients with lymphadenopathy detected at imaging studies, regardless of the suspected underlying clinical aetiology. The Pubmed, Embase, Cinahl, Web of Science and Cochrane Library databases were screened to identify the pertinent literature. Quality of eligible studies was assessed by Quality Assessment, Data Abstraction and Synthesis-2 criteria. Pooled diagnostic yield, sensitivity and specificity were calculated, and a summary receiver operating characteristic curve was constructed. Subgroup analysis was planned to identify possible sources of study heterogeneity. Fourteen studies, collectively involving 2097 patients, fulfilled eligibility criteria. The median prevalence of sarcoidosis was 15%. EBUS-TBNA had a pooled diagnostic yield of 0.79 (standard deviation, 0.24), a pooled sensitivity of 0.84 (95% confidence interval (CI), 0.79-0.88) and a pooled specificity of 1.00 (95% CI, 0.99-1.00). Only subgroup analysis exploring the influence of study design seemed to influence the observed inter-study heterogeneity for sensitivity, retrospective studies showing worst sensitivity than prospective ones. The results of EBUS-TBNA for diagnosis of sarcoidosis in clinically unselected populations are excellent and compare favourably with published results from studies conducted in selected populations. High-quality trials would be needed to evaluate factors possibly explaining the observed heterogeneity in sensitivity.

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Author and article information

Journal

Journal ID (nlm-ta): Mediastinum

Journal ID (iso-abbrev): Mediastinum

Journal ID (publisher-id): MED

Title: Mediastinum

Publisher: AME Publishing Company

ISSN (Electronic): 2522-6711

Publication date (Electronic): 04 December 2023

Publication date Collection: 2024

Volume: 8

Electronic Location Identifier: 2

Affiliations

[1 ]deptRespiratory Department , Queen Elizabeth Hospital , Sabah, Malaysia, ;

[2 ]deptDepartment of Respiratory Medicine , National Hospital Organization Nagoya Medical Center , Nagoya, Japan

Author notes

Contributions: (I) Conception and design: Both authors; (II) Administrative support: M Oki; (III) Provision of study materials or patients: Both authors; (IV) Collection and assembly of data: HY Ramarmuty; (V) Data analysis and interpretation: HY Ramarmuty; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors.

Correspondence to: Masahide Oki, MD. Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan. Email: masahideo@ 123456aol.com .

Article

Publisher ID: med-08-2

DOI: 10.21037/med-23-34

PMC ID: 10839513

PubMed ID: 38322189

SO-VID: 2d20494b-feee-49d1-826f-815bc24a0e70

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Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: a narrative review

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Abstract

Background and Objective

Methods

Key Content and Findings

Conclusions

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Special Issue: Colleges as Anchor Institutions in their Local Community

Most cited references 15

British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults.

Transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: a randomised trial

Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis of sarcoidosis in clinically unselected study populations.

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