Diagnostic value of EBUS-guided transbronchial mediastinal cryobiopsy versus conventional bronchoscopic approaches for stage I/II sarcoidosis: DETECTION-SAR I

Rationale and objectives: A direct comparison between endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), combined with endobronchial biopsy (EBB) and/or transbronchial lung biopsy (TBLB), and endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) for diagnosing sarcoidosis has not been conducted. The aim of the study was to evaluate whether EBUS-TBMC has the same or better diagnostic yield for sarcoidosis than EBUS-TBNA combined with standard bronchoscopic modalities (EBB and/or TBLB). Methods: The records of patients with stage I/II sarcoidosis from four centres in China who underwent EBUS-TBMC or EBUS-TBNA combined with EBB and/or TBLB were retrospectively examined. Data on bronchoscopy examination records, pathological results of bronchoscopic biopsy modalities and postprocedural complications were collected. The outcomes were diagnostic yield and postprocedural complications. Measurements and main results: 84.1%, p<0.001). The diagnostic yield of EBUS-TBNA combined with EBB and/or TBLB was greater than that of EBUS-TBNA alone. No significant differences in diagnostic yield were detected between EBUS-TBMC and EBUS-TBNA combined with EBB and/or TBLB or between EBUS-TBMC and EBUS-TBMC combined with EBB and/or TBLB. No major adverse complications related to the bronchoscopic procedure were observed. Conclusions: EBUS-TBMC exhibited diagnostic yield equivalent to that of EBUS-TBNA combined with EBB and/or TBLB, and superior to that of EBUS-TBNA alone in stage I/II sarcoidosis. The addition of EBB and/or TBLB to EBUS-TBMC did not improve the diagnostic yield of EBUS-TBMC for sarcoidosis. EBUS-TBMC has the potential to reduce the need for EBB and TBLB.