Mediastinal restaging in non-small cell lung cancer: comparing endobronchial ultrasound-guided transbronchial needle aspiration and mediastinal cryobiopsy following neoadjuvant therapy.

Abstract

Background: Accurate mediastinal restaging in patients with non-small cell lung cancer (NSCLC) following neoadjuvant therapy is crucial for treatment planning. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), the standard technique, has limitations such as low diagnostic yield and false negatives, often requiring invasive mediastinoscopy. This study evaluates the performance of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) as a potential alternative to EBUS-TBNA in mediastinal restaging following neoadjuvant therapy. This study compares the diagnostic accuracy of EBUS-TBNA and EBUS-TMC, specifically focusing on diagnostic yield, false-negative rates, sample adequacy for molecular and immunohistochemical analyses, as well as the potential need for mediastinoscopy.

Methods: This prospective study was conducted on 22 NSCLC patients undergoing mediastinal restaging after neoadjuvant therapy from September 2023 to October 2024. Each patient underwent both EBUS-TBNA and EBUS-TMC in the same procedure. Mediastinoscopy was performed only in cases where both EBUS-TBNA and EBUS-TMC results were negative or non-diagnostic, serving as the reference standard.

Results: EBUS-TMC demonstrated superior diagnostic sensitivity (95.45% vs. 63.63%) and achieved sample adequacy for molecular and immunohistochemical analysis in 94.11% of cases compared to 29.41% for EBUS-TBNA. EBUS-TMC identified six additional malignancy cases and had fewer non-diagnostic results (4.5% vs. 22.7%). No complications were reported for any procedure, and mediastinoscopy confirmed all negative EBUS-TMC cases as true negatives.

Conclusions: EBUS-TMC significantly improves diagnostic accuracy and sample adequacy for restaging NSCLC following neoadjuvant therapy, reducing the need for mediastinoscopy. Its integration into clinical practice could enhance patient outcomes, lower healthcare costs, and support personalized treatment strategies. This is the first study to demonstrate EBUS-TMC's transformative potential in thoracic oncology.