{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:41:56Z","timestamp":1787611316127,"version":"build-2736575974"},"reference-count":24,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Excellence & Innovation Initiative of China-Japan Friendship Hospital","award":["ZRZC2025-XYA01"],"award-info":[{"award-number":["ZRZC2025-XYA01"]}]},{"name":"Noncommunicale Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0528900"],"award-info":[{"award-number":["2024ZD0528900"]}]},{"name":"Noncommunicale Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0528902"],"award-info":[{"award-number":["2024ZD0528902"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,3,2]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sarcoidosis frequently involves intrathoracic lymph nodes and lung parenchyma and requires histological confirmation for diagnosis. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is recommended for obtaining mediastinal samples, its diagnostic yield frequently necessitates additional transbronchial lung biopsy (TBLB) and\/or endobronchial biopsy (EBB). EBUS transbronchial mediastinal cryobiopsy (EBUS-TBMC) can yield larger, well-preserved tissue samples than EBUS-TBNA alone. However, whether EBUS-TBMC alone is equivalent to conventional multimodal sampling (EBUS-TBNA combined with TBLB and\/or EBB), and whether TBLB and EBB provide incremental diagnostic value when added to EBUS-TBMC, is still unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>In this study, 410 patients with suspected stage I\/II sarcoidosis will be randomly assigned in a 1:1 ratio to either the EBUS-TBMC or EBUS-TBNA group. All participants will then undergo TBLB and EBB. The primary outcome will be the granuloma detection rate. The diagnostic sensitivity, negative predictive value and procedure-related complications will be selected for secondary outcomes. Statistical analysis will be performed using SPSS V.24.0, with non-inferior testing for the primary comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approval for this DETECTION-SAR-II trial was obtained by the China-Japan Friendship Hospital Ethics Committee (Ethics number: 2025-KY-075). Participants will be fully informed of objectives, protocol and potential risks of the study before enrolment and will provide written informed consent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07246876\">NCT07246876<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-004065","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:35:18Z","timestamp":1773934518000},"page":"e004065","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Value of EBUS-guided Transbronchial MEdiastinal Cryobiopsy versus ConvenTIONal Bronchoscopic Approaches for Intrathoracic Stage I\/II SARcoidosis: protocol for a randomised controlled trial (DETECTION-SAR-II)"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct07246876","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07246876","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ziwen","family":"Zheng","sequence":"first","affiliation":[{"name":"National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Henan Institute of Interconnected Intelligent Health, Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junwei","family":"Guo","sequence":"additional","affiliation":[{"name":"National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quncheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Zhengzhou University People\u2019s Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xu","sequence":"additional","affiliation":[{"name":"Shandong Provincial Public Health Clinical Center, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Ming","family":"Deng","sequence":"additional","affiliation":[{"name":"National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Herth","sequence":"additional","affiliation":[{"name":"Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Centre Heidelberg, University of Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venerino","family":"Poletti","sequence":"additional","affiliation":[{"name":"Department of Diseases of the Thorax, GB Morgagni Hospital, Forl\u00ec, Italy; Department Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3438-1764","authenticated-orcid":false,"given":"Gang","family":"Hou","sequence":"additional","affiliation":[{"name":"National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"2026031908351348000_13.1.e004065.1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9041081","article-title":"Sarcoidosis: Causes, Diagnosis, Clinical Features, and Treatments","volume":"9","author":"Jain","year":"2020","journal-title":"J Clin Med"},{"key":"2026031908351348000_13.1.e004065.2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.rmed.2018.11.010","article-title":"Sarcoidosis deaths in the United States: 1999-2016","volume":"149","author":"Kearney","year":"2019","journal-title":"Respir Med"},{"key":"2026031908351348000_13.1.e004065.3","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-216732"},{"key":"2026031908351348000_13.1.e004065.4","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000007595","article-title":"Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis: Cohort study of a 40-year clinical experience at a tertiary referral center in Barcelona, Spain","volume":"96","author":"Ma\u00f1\u00e1","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2026031908351348000_13.1.e004065.5","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201010-1679OC"},{"key":"2026031908351348000_13.1.e004065.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2015.10.024"},{"key":"2026031908351348000_13.1.e004065.7","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202002-0251ST"},{"key":"2026031908351348000_13.1.e004065.8","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2019-214348"},{"key":"2026031908351348000_13.1.e004065.9","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.4103\/0366-6999.184458","article-title":"Endobronchial Ultrasound-guided Transbronchial Needle Aspiration versus Standard Bronchoscopic Modalities for Diagnosis of Sarcoidosis: A Meta-analysis","volume":"129","author":"Hu","year":"2016","journal-title":"Chin Med J (Engl)"},{"key":"2026031908351348000_13.1.e004065.10","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/eus.0000000000000063","article-title":"Endobronchial ultrasound-guided transbronchial tunnel Cryobiopsy for mediastinal lymphadenopathy (with video)","volume":"13","author":"Deng","year":"2024","journal-title":"Endosc Ultrasound"},{"key":"2026031908351348000_13.1.e004065.11","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1159\/000540645","article-title":"A Novel Procedure for Endobronchial Ultrasound-Guided Transbronchial Mediastinal Cryobiopsy with a Puncture Dilation Catheter","volume":"103","author":"Tong","year":"2024","journal-title":"Respiration"},{"key":"2026031908351348000_13.1.e004065.12","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00055-2021","article-title":"Transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: a randomised trial","volume":"58","author":"Zhang","year":"2021","journal-title":"Eur Respir J"},{"key":"2026031908351348000_13.1.e004065.13","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/eus.0000000000000147","article-title":"Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy versus transbronchial needle aspiration for diagnosing sarcoidosis: A randomized controlled trial","volume":"14","author":"Deng","year":"2025","journal-title":"Endosc Ultrasound"},{"key":"2026031908351348000_13.1.e004065.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-096871","article-title":"Comparison of diagnostic yield and safety of three endobronchial ultrasound-guided transbronchial biopsy techniques in diagnosing patients with mediastinal\/hilar lymphadenopathy: a protocol of multicentre randomised trial in China","volume":"15","author":"Deng","year":"2025","journal-title":"BMJ Open"},{"key":"2026031908351348000_13.1.e004065.15","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12450"},{"key":"2026031908351348000_13.1.e004065.16","doi-asserted-by":"crossref","first-page":"108294","DOI":"10.1016\/j.rmed.2025.108294","article-title":"Diagnostic performance and safety of endobronchial ultrasound-guided transbronchial cryobiopsies in the diagnosis of mediastinal lesions","volume":"247","author":"Rosell\u00f3","year":"2025","journal-title":"Respir Med"},{"key":"2026031908351348000_13.1.e004065.17","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201202-0320ST"},{"key":"2026031908351348000_13.1.e004065.18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/resp.14182","article-title":"EBUS versus EUS-B for diagnosing sarcoidosis: The International Sarcoidosis Assessment (ISA) randomized clinical trial","volume":"27","author":"Crombag","year":"2022","journal-title":"Respirology"},{"key":"2026031908351348000_13.1.e004065.19","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-69702-y","article-title":"An explorative analysis on the optimal cryo-passes and freezing time of the ultrathin cryoprobe in endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy","volume":"14","author":"Kho","year":"2024","journal-title":"Sci Rep"},{"key":"2026031908351348000_13.1.e004065.20","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.pulmoe.2023.11.008","article-title":"EBUS-guided cryobiopsy in the diagnosis of thoracic disorders","volume":"30","author":"Poletti","year":"2024","journal-title":"Pulmonology"},{"key":"2026031908351348000_13.1.e004065.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.07.013"},{"key":"2026031908351348000_13.1.e004065.22","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.1.109"},{"key":"2026031908351348000_13.1.e004065.23","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S1499-3872(15)60367-8","article-title":"Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas: diagnostic efficacy of cell-block immunocytochemistry","volume":"14","author":"Ieni","year":"2015","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"2026031908351348000_13.1.e004065.24","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3003.1999.14d02.x"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-004065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:35:20Z","timestamp":1773934520000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-004065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3,19]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bmjresp-2025-004065"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-004065","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}