{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:03:51Z","timestamp":1784538231163,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Accurate diagnosis of lymph node pathology is essential for the management of both malignant and benign diseases. This study compares the diagnostic performance of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a real-world cohort. Methods: A single-center retrospective observational study was conducted, including 91 patients who underwent both cryobiopsy and EBUS-TBNA for lymph node evaluation. EBUS-TBNA was performed with a 19-G needle and cryobiopsy with a 1.1 mm flexible cryoprobe. Clinical characteristics, positron emission tomography\u2013computed tomography (PET\u2013CT) findings, ultrasonographic characteristics of the lymph nodes, diagnostic yield, and procedure-related complications were analyzed. Diagnostic accuracy, sensitivity, specificity, and factors associated with correct diagnosis were assessed. Results: The median age of the cohort was 65 years [interquartile range-IQR-56\u201374], 63.7% were male, and 74.7% were former or current smokers. Malignant disease was ultimately diagnosed in 60 patients (65.9%), of whom 78.3% had non-lymphoproliferative tumours and 21.7% had lymphoproliferative malignancies. The diagnostic accuracy of cryobiopsy was 89%, compared with 82.4% for EBUS-TBNA. The paired comparison between the two techniques did not reach statistical significance. After exclusion of non-diagnostic samples, sensitivity was numerically higher for cryobiopsy (96.4%, 95% CI 90.7\u2013100) than for EBUS-TBNA (88.9%, 95% CI 79.6\u201398.2). Factors associated with correct diagnosis included chronic obstructive pulmonary disease for cryobiopsy, cardiovascular comorbidities, and maximum SUV for EBUS-TBNA. In malignant lesions, cryobiopsy showed higher diagnostic accuracy than EBUS-TBNA (90% vs. 80% accuracy), particularly in lymphoproliferative diseases. In benign lesions, both techniques agreed in 17 (54%) of cases, with cryobiopsy showing a higher yield for sarcoidosis and contributing to the diagnosis of tuberculosis. Complications were infrequent and minor, with no major adverse events reported. Conclusions: Cryobiopsy showed numerically higher diagnostic accuracy and sensitivity compared with EBUS-TBNA, particularly in malignant and lymphoproliferative disorders, with a favorable safety profile. These findings support its role as a valuable complement\u2014or alternative\u2014to conventional EBUS-TBNA in the assessment of mediastinal lymph nodes.<\/jats:p>","DOI":"10.3390\/jcm15145656","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:54:13Z","timestamp":1784534053000},"page":"5656","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cryobiopsy Outperforms Fine-Needle Aspiration for Mediastinal Lymphadenopathy: A Within-Patient Diagnostic Accuracy Study and Clinical Predictors of Success"],"prefix":"10.3390","volume":"15","author":[{"given":"Mar\u00eda","family":"Hidalgo","sequence":"first","affiliation":[{"name":"Department of Pulmonology, La Paz\u2013Cantoblanco\u2013Carlos III University Hospital, Faculty of Medicine, UAM, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4090-4306","authenticated-orcid":false,"given":"Carlos","family":"Carpio","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, La Paz\u2013Cantoblanco\u2013Carlos III University Hospital, Faculty of Medicine, UAM, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Alcolea","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, La Paz\u2013Cantoblanco\u2013Carlos III University Hospital, Faculty of Medicine, UAM, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2459-3624","authenticated-orcid":false,"given":"Pablo","family":"Mariscal","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, La Paz\u2013Cantoblanco\u2013Carlos III University Hospital, Faculty of Medicine, UAM, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0728-6235","authenticated-orcid":false,"given":"Maria Alejandra","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Nuestra Se\u00f1ora de Sonsoles Hospital, 05004 \u00c1vila, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Pathology, La Paz-Cantoblanco-Carlos III University Hospital, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Esteban","sequence":"additional","affiliation":[{"name":"Department of Pathology, La Paz-Cantoblanco-Carlos III University Hospital, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Pathology, La Paz-Cantoblanco-Carlos III University Hospital, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"\u00c1lvarez-Sala","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, La Paz\u2013Cantoblanco\u2013Carlos III University Hospital, Faculty of Medicine, UAM, IdiPAZ, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"202S","DOI":"10.1378\/chest.07-1362","article-title":"Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)","volume":"132","author":"Detterbeck","year":"2007","journal-title":"CHEST"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"The American Thoracic Society and The European Respiratory Society (1997). 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