Optimizing the endoscopic diagnosis of mediastinal lymphadenopathy: a glimpse on cryobiopsy

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 sensit...

Full description

Saved in:
Bibliographic Details
Published in:BMC pulmonary medicine Vol. 22; no. 1; pp. 1 - 4
Main Authors: Mondoni, Michele, Sotgiu, Giovanni
Format: Journal Article
Language:English
Published: London BioMed Central 19.09.2022
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Accuracy
Biopsy
Care and treatment
Commentary
Critical Care Medicine
Cryobiopsy
Crystallization
Diagnosis
EBUS-TBNA
Endoscopy
Endosonography
Immunoproliferative diseases
Intensive
Internal Medicine
Invasiveness
Lung cancer
Lung diseases
Lungs
Lymph nodes
Lymphadenitis
Lymphadenopathy
Lymphatic system
Lymphocytes
Lymphoma
Malignancy
Mediastinal lymph nodes
Medicine
Medicine & Public Health
Methods
Patients
Pneumology/Respiratory System
Pulmonary lesions
Sampling
Sarcoidosis
Systematic review
Ultrasonic imaging
Ultrasound
Italy
Mediastinal lymph nodes
Tuberculosis
Endosonography
Sarcoidosis
Lung cancer
EBUS-TBNA
Cryobiopsy
Lymphoma
ISSN:1471-2466, 1471-2466
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
Bibliography:SourceType-Scholarly Journals-1
ObjectType-Commentary-1
content type line 14
content type line 23
ObjectType-Correspondence-1
ISSN:1471-2466
1471-2466
DOI:10.1186/s12890-022-02160-2