Transbronchial needle core biopsy versus aspiration under endobronchial ultrasound guidance: a meta-analysis

Background Endobronchial ultrasound-guided transbronchial needle core biopsy (EBUS-TBNB) is an emerging technique designed to obtain histological specimens from mediastinal lesions. This meta-analysis aims to compare the performance of EBUS-TBNB versus endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal disorders. Methods A thorough search of the literature was performed across PubMed, Embase and Web of Science databases, covering the period from their inception through 1 October 2025. Diagnostic yields were pooled via inverse variance weighting using fixed- or random-effects models based on heterogeneity. Complications were carefully assessed and categorised. Results 11 studies involving 1434 patients were analysed. The pooled diagnostic yield was 88.51% (678/766) for EBUS-TBNB and 80.11% (741/925) for EBUS-TBNA, with an odds ratio of 2.04 (95% CI 1.52–2.74; p<0.00001) and I 2 =23%. Subgroup analysis showed significantly higher yield with EBUS-TBNB for lymphoma (OR 5.22, 95% CI 1.12–24.26; p=0.04) and sarcoidosis (OR 2.88, 95% CI 1.64–5.04; p=0.0002), while no significant difference was observed for lung cancer (OR 1.18, 95% CI 0.77–1.81; p=0.45). The safety profiles of EBUS-TBNB and EBUS-TBNA were favourable, with low complication rates and no procedure-related mortality. Conclusion Current pooled evidence suggests a possible diagnostic advantage of EBUS-TBNB over EBUS-TBNA, particularly for lymphoma and sarcoidosis, with a similar safety profile. However, this apparent benefit should be interpreted cautiously given the limited randomised evidence, heterogeneity across needle platforms and substantial contribution of observational studies.