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Updated: Aug 28, 2025
Author Spotlight: Expanding Interventional Pulmonology Research with Robotic-Assisted Bronchoscopy
Published on: July 19, 2024
Optimizing the endoscopic diagnosis of mediastinal lymphadenopathy: a glimpse on cryobiopsy
Michele Mondoni1, Giovanni Sotgiu2
1Respiratory Unit, ASST Santi Paolo E Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via A. Di Rudinì n.8, 20142, Milan, Italy. michele.mondoni@asst-santipaolocarlo.it.
Insights
Mediastinal cryobiopsy, a novel bronchoscopic technique, offers larger tissue samples for diagnosing mediastinal lymphadenopathy, potentially improving molecular assessments and complementing traditional methods like EBUS-TBNA.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Diagnostic Imaging
Background:
- Mediastinal lymphadenopathy diagnosis is challenging, with endosonography (EBUS-TBNA) being standard but sometimes yielding insufficient tissue for molecular analysis.
- Cryobiopsy, successful in interstitial lung disease diagnosis, provides larger tissue samples and is being explored for mediastinal lymph nodes.
Discussion:
- A recent study explored ultrasound-guided transbronchial cryobiopsy after EBUS-TBNA for mediastinal lymphadenopathy in suspected malignancies.
- The potential added value of mediastinal cryobiopsy for histopathological and molecular assessment in malignancies was discussed.
Key Insights:
- EBUS-cryobiopsy shows promise for diagnosing mediastinal lymphadenitis, offering larger tissue yields than conventional methods.
- Cryobiopsy may enhance histopathological and molecular assessments, crucial for advanced lung cancer and other lymph node disorders.
Outlook:
- Mediastinal cryobiopsy requires further research to clarify its learning curve, optimal strategies, diagnostic accuracy, and safety.
- This technique is likely complementary to conventional endosonography, with rapid on-site evaluation guiding its use.
Abstract:
Etiological diagnosis of mediastinal lymphadenopathy represents a daily challenge. Endosonography (transesophageal and transbronchial ultrasound-guided needle aspiration) is the recommended technique in the first diagnostic work-up and in the mediastinal staging of lung cancer. Despite a good sensitivity, limited amount of collected tissue may hamper molecular assessment in advanced lung cancer and in the diagnosis of lymphoproliferative disorders, fibrotic sarcoidosis, and mycobacterial lymphadenitis. Cryobiopsy, a bronchoscopic technique based on cooling, crystallization, and subsequent collection of tissue, has been successfully employed in the diagnosis of interstitial lung diseases. Cryoprobes provide larger amount of tissue than conventional bronchoscopic sampling tools and might potentially prevent the need for invasive surgical procedures. New applications of the technique (e.g., bronchoscopic diagnosis of peripheral pulmonary lesions and mediastinal lymph nodes) have been recently described in few reports. In a recent issue of the Journal, Genova et al. described five patients who underwent endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) followed by ultrasound-guided transbronchial cryobiopsy of mediastinal lymphadenopathy for a suspected malignancy. The authors discussed about the potential added value of mediastinal cryobiopsy on a correct histopathological and molecular assessment in patients with malignancies. EBUS-cryobiopsy could be a promising technique in the diagnostic pathway of mediastinal lymphadenitis. However, cryobiopsy is now available only in few selected centres. The learning curve of the technique adapted to mediastinal ultrasound-guided sampling, the optimal sampling strategy, its true diagnostic accuracy in patients with malignant and benign diseases, as well as its safety, are still largely unclear. Mediastinal cryobiopsy could be complementary rather than alternative to conventional endosonography. Rapid on-site evaluation of EBUS-TBNA could guide subsequent sampling with cryoprobes in case of poor collection of biological material or in case of suspected lymphoproliferative disorders. Further studies should investigate its diagnostic yield, in comparison or in combination with conventional endosonography, in large cohorts of patients with malignant or benign mediastinal lymphadenopthies.
