Soo Chun Ian, Kho Sze Shyang, Leong Wai Ling, Eng Shinye, Ong Diana Bee-Lan, Chiew Seow Fan, Chow Tak Kuan, Annuar Hazwan Amzar Khairul, Wong Chee Kuan, Liam Chong Kin
Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
Pulm Med. 2025 Aug 28;2025:3522554. doi: 10.1155/pm/3522554. eCollection 2025.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established procedure for diagnosing thoracic diseases and staging of lung cancers. However, some limitations of cytology specimens from EBUS-TBNA include small sample size, low tumour cellularity, necrosis and specimen contamination. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) is a promising alternative that provides a larger histology specimen which may improve diagnostic accuracy and molecular testing. This study is aimed at evaluating the benefits of EBUS-TBMC over EBUS-TBNA, focusing on improving next-generation sequencing (NGS) success rates, and assessing its efficacy and safety in a real-world setting. Data from 203 patients (99 underwent EBUS-TBNA and 104 underwent EBUS-TBMC) were retrospectively traced and analysed using descriptive statistics. The overall diagnostic yield was significantly higher for EBUS-TBMC (90.38%) than that for EBUS-TBNA (67.68%; < 0.001). For heterogeneous lesions, the diagnostic yield was 92.31% for EBUS-TBMC and 69.44% for EBUS-TBNA ( = 0.011). For non-small-cell lung cancer (NSCLC), EBUS-TBMC specimens demonstrated higher overall tumour cellularity (65% vs. 30%; < 0.001) and better success in detecting driver alterations through NGS (85.36% vs. 61.90%; = 0.035). The median procedure duration was shorter for EBUS-TBMC (22 vs. 32 min; < 0.001), and the complication rates were comparable between the two techniques. These findings suggest that EBUS-TBMC offers additional diagnostic advantages over EBUS-TBNA for heterogeneous lesions and significantly facilitates the acquisition of cell-rich specimens for NGS testing. EBUS-TBMC increases the overall diagnostic yield of mediastinal diseases. EBUS-TBMC provides cell-rich histology specimens with high tumour content, facilitating NGS testing in the management of NSCLC.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是诊断胸部疾病和肺癌分期的既定方法。然而，EBUS-TBNA获取的细胞学标本存在一些局限性，包括样本量小、肿瘤细胞含量低、坏死和标本污染。支气管内超声引导下经支气管纵隔冷冻活检术（EBUS-TBMC）是一种很有前景的替代方法，它能提供更大的组织学标本，可能提高诊断准确性和分子检测水平。本研究旨在评估EBUS-TBMC相对于EBUS-TBNA的优势，重点是提高二代测序（NGS）成功率，并在实际临床环境中评估其有效性和安全性。对203例患者（99例行EBUS-TBNA，104例行EBUS-TBMC）的数据进行回顾性追踪，并采用描述性统计方法进行分析。EBUS-TBMC的总体诊断率（90.38%）显著高于EBUS-TBNA（67.68%；P<0.001）。对于异质性病变，EBUS-TBMC的诊断率为92.31%，EBUS-TBNA为69.44%（P=0.011）。对于非小细胞肺癌（NSCLC），EBUS-TBMC标本显示出更高的总体肿瘤细胞含量（65%对30%；P<0.001），并且通过NGS检测驱动基因突变的成功率更高（85.36%对61.90%；P=0.035）。EBUS-TBMC的中位操作时间更短（22分钟对32分钟；P<0.001），两种技术的并发症发生率相当。这些发现表明，对于异质性病变，EBUS-TBMC相对于EBUS-TBNA具有额外的诊断优势，并且显著便于获取富含细胞的标本用于NGS检测。EBUS-TBMC提高了纵隔疾病的总体诊断率。EBUS-TBMC提供了肿瘤含量高且富含细胞的组织学标本，便于在NSCLC的管理中进行NGS检测。
