Transbronchial Mediastinal Cryobiopsy Diagnostic Yield and Perioperative Patient Management: A Single Tertiary Center Experience.

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to diagnose mediastinal lesions; however, small cytology samples from EBUS-TBNA may be inadequate in cases of benign lung diseases, hematologic disorders, and to assess the molecular profile of primary lung cancer (PLC). EBUS-guided transbronchial mediastinal cryobiopsy (TMC) obtains histological samples and potentially implies a higher diagnostic yield (DY) than EBUS-TBNA. The clinical impact of this technique and the perioperative patient management are still unclear. Our aim was to critically analyze our experience with TMC.

Material and methods: A single center retrospective study was conducted to evaluate TMC DY and perioperative routine over 11 months (February 2023-January 2024).

Results: Forty-one patients were included. The overall DY was 41.5% and 95.1% for EBUS-TBNA and TMC, respectively. TMC provided a higher DY than EBUS-TBNA in cases of hematologic disorders, benign diseases, and uncommon tumors (31% for EBUS-TBNA and 100% for TMC; 95% confidence interval (CI): 52.1-85.8, P < 0.001). For PLC, the DY and the assessment of immunohistochemical marker expression did not significantly differ between the two techniques (80% for EBUS-TBNA and 100% for TMC; 95% CI: -4.79-44.8, P = 0.13). The management of antithrombotic therapy was the same as that of EBUS-TBNA. Sedatives were administered to achieve deep sedation. After the procedure, no step-up in the level of care was observed, either in outpatients or in patients with a Charlson Comorbidity Index ≥5.

Conclusion: TMC had a better DY than EBUS-TBNA in hematologic disorders, benign lung disease, and uncommon tumors, with an optimal tolerability profile.