Mediastinal Cryobiopsy: Bridging the Histology Gap in Endoscopic Thoracic Nodal Sampling
David Heath1,2, Anna McLean1,3, Lauren K. Troy1,3
1Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
2Department of Respiratory Medicine, Concord Repatriation General Hospital, Sydney, Australia
3Sydney Medical School, University of Sydney, Australia
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard minimally invasive technique for mediastinal and hilar evaluation but as a cytologic specimen, is limited when histologic architecture or larger tissue volume is required. EBUS-guided mediastinal cryobiopsy (EBUS-MCB) extends diagnostic capability beyond TBNA by retrieving intact, architecturally preserved tissue cores through the same bronchoscope.
Since introduction into clinical practice in 2020, cryobiopsy combined with standard TBNA has been adopted widely, recognised by many as a significant advance in endoscopic mediastinal diagnosis. Several studies show that MCB has higher diagnostic yield than corresponding TBNA, with the greatest benefit seen in benign granulomatous and lymphoproliferative disorders. MCB has also shown superior performance for molecular profiling in non-small-cell lung cancer as a secondary endpoint in several studies. Complications are uncommon, usually limited to minor bleeding, with serious adverse events reported in fewer than 2% of procedures.
EBUS-MCB added in stepwise fashion to standard TBNA appears to be of greatest utility when paucicellular or non-diagnostic sampling is determined at rapid onsite cytological evaluation (ROSE) or at prior EBUS-TBNA procedure. In cases where there is high pre-test probability for lymphoma, EBUS-TBNA-MCB may reasonably be performed without ROSE feedback, potentially avoiding the need for more invasive and costly diagnostic procedures.
Integration of MCB into selected EBUS procedures has the potential to meaningfully improve diagnostic yield and refine disease subtyping, with downstream implications for treatment selection and patient outcomes. Its use should be tailored to centre-specific resources, expertise and local disease epidemiology to maximise benefit and ensure appropriate implementation.
DOI: 10.29245/2689-999X/2026/1.1189 View / Download Pdf