Early experience of endobronchial ultrasound-guided transbronchial nodal cryobiopsy: a case series from Sabah, Malaysia

• Main Authors: Hema Yamini Ramarmuty, Nai-Chien Huan, Larry Ellee Nyanti, Teng Shin Khoo, Tamilarasi Renganathan, Ahmad Zaki Manoh, Nusaibah Azman, Kunji Kannan Sivaraman Kannan
• Format: Article
• Language: English; English
• Published: SAGE Publications 2024
• Subjects: RC254-282 Neoplasms. Tumors. Oncology Including cancer and carcinogens; RC705-779 Diseases of the respiratory system
• Online Access: https://eprints.ums.edu.my/id/eprint/38832/1/ABSTRACT.pdf; https://eprints.ums.edu.my/id/eprint/38832/2/FULL%20TEXT.pdf; https://eprints.ums.edu.my/id/eprint/38832/; https://doi.org/10.1177/17534666241231122

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive method for the diagnosis of benign and malignant conditions. Continuous efforts are underway to improve the material adequacy of EBUSTBNA, including the introduction of a new technique called EBUS-guided transbronchial nodal cryobiopsy (EBUS-TBNC). This method allows for the retrieval of larger and wellpreserved histologic samples from the mediastinum. We present a case series of four patients who underwent combined EBUS-TBNA and EBUS-TBNC procedures in our centre. All procedures were performed under general anaesthesia using a convex probe EBUS scope (Pentax EB-1970UK). Two patients were diagnosed with malignancy and two with benign disorders (silicosis and tuberculosis). In the malignant cases, both EBUS-TBNA/cell block and cryobiopsy provided a diagnosis but cryobiopsy yielded more material for ancillary tests in one patient. However, in the benign cases, there was discordance between EBUS-TBNA/cell block and cryobiopsy. Only cryobiopsy detected granuloma in the patient with TB (tuberculosis), and in the patient with silicosis, TBNC provided a better overall histological evaluation, leading to a definitive diagnosis. No complications were observed. This case series supports the potential diagnostic value of combining EBUS-TBNA and EBUS-TBNC, particularly in benign mediastinal lesions (granulomatous diseases), and in cases requiring additional molecular tests in cancer diagnosis.