Endoscopic ultrasound-guided transoesophageal biopsy (EUS-FNA/FNB) is a minimally invasive and highly accurate diagnostic technique for evaluating mediastinal lesions, particularly in centres where surgical approaches or endobronchial ultrasound are unavailable. We report the case of a 79-year-old woman with multiple comorbidities who presented with non-specific abdominal pain and a 5 kg weight loss over 1 month. Imaging revealed a 50% left pleural effusion and mediastinal and retroperitoneal lymphadenopathy. Endoscopic ultrasound demonstrated hilar, retroperitoneal and interaortocaval lymph nodes, prompting a transoesophageal fine-needle biopsy using a 22G needle and fanning technique, which was performed without complications. Initial histopathology suggested a lymphoproliferative process, and a subsequent excisional lymph node biopsy confirmed classical mixed-cellularity Hodgkin lymphoma associated with Epstein–Barr virus. This case highlights the diagnostic value of EUS-FNA/FNB in mediastinal lesions that are difficult to access using traditional techniques. Although its diagnostic yield is high, lymphomas—particularly Hodgkin lymphoma—may require additional tissue sampling to preserve architectural detail. Procedure success depends on sample adequacy, needle selection and operator expertise. Integrating EUS-guided biopsy into a multidisciplinary diagnostic pathway enables safe, effective and timely evaluation of mediastinal pathology, especially in resource-limited settings or in patients with significant comorbidities.
Alvarado-Hernández et al. (Wed,) studied this question.