Abstract Rationale Endobronchial ultrasound (EBUS)-guided transbronchial mediastinal and hilar lymph node cryobiopsy (EBUS-TMC) provides higher diagnostic yield and superior tissue quality compared to conventional EBUS-guided transbronchial needle aspiration (EBUS-TBNA) in adults, particularly for benign conditions and lymphoproliferative disorders. In cases of suspected lymphoproliferative disorders, larger tissue samples are needed to minimize sampling error, while smaller samples are sufficient for diagnosing solid tumors. Data regarding EBUS-TMC use in children are limited. We aim to characterize our early clinical experience, safety, and diagnostic yield of EBUS-TMC in a pediatric population. Methods This single-center, retrospective cohort study included patients who underwent EBUS-TMC for evaluation of mediastinal and hilar lesions. Demographic, procedural, and outcome data were collected. Results Thirteen procedures were performed in 11 patients aged 4-19 years between July 2024 and July 2025. All procedures were performed using a 1.1 mm cryoprobe through the working channel of the linear EBUS bronchoscope and advanced into the previously created needle track. A 3-8 second freeze time was used, yielding 3-16 specimens per procedure. Tissue samples measured from 2-6 mm in diameter. The most common indications for biopsy were mediastinal lymphadenopathy (38%) and hilar lymphadenopathy (31%). Tissue adequacy was 100%. A pathologic diagnosis was made based on tissue alone in 38% of cases and following multidisciplinary discussion in 62%. Multidisciplinary discussion incorporated pathology findings, culture results, and clinical context. Normal or reactive lymph node tissue was present in 54%. None of the patients with normal or reactive lymph node tissue were later diagnosed with malignancy during a follow-up period of up to 18 months, with a median follow-up of 10 months. Two patients had multiple biopsies. One patient required repeat biopsy due to lack of diagnostic certainty, and one patient required repeat biopsy due to subsequent infection. None of these patients required subsequent surgical lymph node biopsy. Diagnoses were benign infectious in 38%, malignant in 23%, and benign non-infectious in 15%. Mild bleeding occurred in 61% of procedures (grade 1-2). No severe bleeding or pneumothoraces were observed. Conclusions EBUS-TMC was feasible and safe in this pediatric cohort, providing adequate tissue for diagnosis with an acceptable safety profile and avoiding more invasive surgical biopsy. These findings suggest that EBUS-TMC can serve as a valuable adjunct or alternative to conventional sampling techniques for evaluating mediastinal and hilar pathology in children. Larger multicenter studies are needed to further define its diagnostic yield and optimal role in pediatric practice. This abstract is funded by: None
Haskett et al. (Fri,) studied this question.
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