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September 5, 2025Open Access

Performance of Endobronchial Ultrasound‐Guided Cryobiopsy in Diagnosing Thoracic Disorders and Its Role in Next‐Generation Sequencing for Non‐Small‐Cell Lung Cancer

Puntos clave

EBUS-TBMC significantly increases the diagnostic yield for thoracic disorders compared to EBUS-TBNA.
Diagnostic yield for heterogeneous lesions was 92.31% with EBUS-TBMC versus 69.44% with EBUS-TBNA.
Cellular content in NSCLC specimens was significantly higher with EBUS-TBMC, aiding next-generation sequencing.
Overall complication rates were similar for both EBUS-TBNA and EBUS-TBMC procedures.

Resumen

Background: Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is an established procedure for diagnosing thoracic diseases and staging of lung cancers. However, some limitations of cytology specimens from EBUS‐TBNA include small sample size, low tumour cellularity, necrosis and specimen contamination. Endobronchial ultrasound‐guided transbronchial mediastinal cryobiopsy (EBUS‐TBMC) is a promising alternative that provides a larger histology specimen which may improve diagnostic accuracy and molecular testing. This study is aimed at evaluating the benefits of EBUS‐TBMC over EBUS‐TBNA, focusing on improving next‐generation sequencing (NGS) success rates, and assessing its efficacy and safety in a real‐world setting. Methods: Data from 203 patients (99 underwent EBUS‐TBNA and 104 underwent EBUS‐TBMC) were retrospectively traced and analysed using descriptive statistics. Results: The overall diagnostic yield was significantly higher for EBUS‐TBMC (90.38%) than that for EBUS‐TBNA (67.68%; p < 0.001). For heterogeneous lesions, the diagnostic yield was 92.31% for EBUS‐TBMC and 69.44% for EBUS‐TBNA ( p = 0.011). For non‐small‐cell lung cancer (NSCLC), EBUS‐TBMC specimens demonstrated higher overall tumour cellularity (65% vs. 30%; p < 0.001) and better success in detecting driver alterations through NGS (85.36% vs. 61.90%; p = 0.035). The median procedure duration was shorter for EBUS‐TBMC (22 vs. 32 min; p < 0.001), and the complication rates were comparable between the two techniques. These findings suggest that EBUS‐TBMC offers additional diagnostic advantages over EBUS‐TBNA for heterogeneous lesions and significantly facilitates the acquisition of cell‐rich specimens for NGS testing. Conclusion: EBUS‐TBMC increases the overall diagnostic yield of mediastinal diseases. EBUS‐TBMC provides cell‐rich histology specimens with high tumour content, facilitating NGS testing in the management of NSCLC.

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