C110-03 EBUS-Guided Transbronchial Intranodal Cryobiopsy (TBINCB) Following Non-Diagnostic Transbronchial Needle Aspiration (TBNA) in Patients With Enlarged Mediastinal/Hilar Lymphnodes - A Single Center Experience

Abstract Rationale Endobronchial ultrasound-guided (EBUS) TBNA is the current standard for minimally invasive sampling of mediastinal/hilar lymph nodes. However, cytological specimen may not be sufficient for diagnosis requiring preserved tissue architecture. EBUS-guided TBINCB has recently emerged as a new method to improve diagnosis by providing histological samples. Methods This single-center study was done in patients presenting with a clinical diagnosis of tuberculosis, sarcoidosis, bronchogenic carcinoma or lymphoma and mediastinal/hilar lymphadenopathy, defined by at least one lymphnode with short-axis diameter > 10 mm.Between January 2025 and June 2025 participating patients underwent EBUS TBNA followed by EBUS TBINCB, whenever the rapid onsite exam (ROSE) following TBNA was non-diagnostic. Only enlarged lymph nodes (short-axis > 10 mm) were sampled.The primary objective was to determine whether EBUS-guided TBINCB, following non-diagnostic TBNA, increases diagnostic yield. The secondary objective was to describe the procedural risk associated with TBNA and TBINCB. Statistical analysis was done with either McNemar’s, Fisher’s or T-tests. Results We included 30 patients (73% male, mean age 58 yrs) with non-diagnostic ROSE following TBNA, and 2 patients with non-diagnostic ROSE but diagnostic cytological exam done at pathology.In 28 patients (93.3%) with non-conclusive ROSE during bronchoscopy and non-conclusive cytology at pathology, definitive histopathological diagnosis was reached with EBUS-guided TBINCB in 19 patients (67.9%) (p < 0,001); and according to clinical diagnosis, sarcoidosis was defined histologically in 15 patients, bronchial carcinoma in 2 patients and tuberculosis in 2 patients, respectively.Two patients yielded concordant findings for TBNA cytology at pathology and TBINCB histology: one was diagnosed with sarcoidosis and one with lymphoma.Regarding procedural risk, no major complication occurred neither during or following EBUS-guided TBNA or TBINCB (no major bleeding, no pneumothorax). We observed only minor oozing at the puncture site (TBNA 30 patients, TBINCB 23 patients) and mild self-limiting bleeding of < 10 mL (TBNA 0 patients, TBINCB 7 patients). Conclusion EBUS-guided TBINCB following non-diagnostic EBUS TBNA is a safe and effective procedure significantly increasing diagnostic yield, and not increasing procedural risk. This abstract is funded by: None