Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: Insights and technical tips from our early experience with 30 patients

BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to diagnose and stage lung cancer. In real-life practice, limitations are seen with cytology samples from EBUS-TBNA. Obtaining adequate samples can be challenging when faced with necrotic lesions with low cellular yield and the evolving landscape of targeted therapy, necessitating additional samples for comprehensive testing. Hence, transbronchial mediastinal cryobiopsy guided by endobronchial ultrasound (EBUS-TBMC) has emerged as a promising approach for obtaining larger tissue samples. In retrospective review, our aim is to present our early experience regarding the feasibility of performing EBUS-TBMC, employing a similar approach to EBUS-TBNA, followed by the outcomes of our procedures. We include a step-by-step explanation and some recommendations to conduct a successful EBUS-TBMC. MethodSingle center retrospective analysis to evaluate the feasibility and utility of EBUS-TBMC cases over six months from July to December 2022. Results36 EBUS-TBMC procedures on 30 patients. Moderate sedation was used in 80% of cases. Majority (83.4%) of the patients had biopsy of a single lesion with a median of 3 cryobiopsies (Interquartile range 3-4). The median cryo-activation time was 6 seconds (Interquartile range 6-8). EBUS-TBMC demonstrated a positive yield of 86.1% with an overall diagnostic yield of 83.3%. Mild bleeding occurred in six biopsies (16.7%) which did not required further intervention. No other major complications were observed. ConclusionEBUS-TBMC is a safe and effective alternative to EBUS-TBNA. Histology samples obtained through EBUS-TBMC have the potential to increase confidence in diagnosing and staging lung cancer, thereby alleviating concerns about tissue inadequacy.