Diagnostic value and safety of contact laser-assisted endotracheal ultrasound-guided tunnel drilling biopsy in mediastinal and hilar lymphadenopathy: a retrospective study

Background: Mediastinal and hilar lymphadenopathies are primarily diagnosed pathologically. Compared to traditional endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), contact laser-assisted endobronchial ultrasound-guided tunnel drilling biopsy (EBUS-TDB) using a laser as a tunnelling and incision tool may yield more satisfactory specimens, thereby improving the diagnostic yield. Therefore, this study aims to evaluate the diagnostic value and safety of contact laser-assisted EBUS-TDB compared to EBUS-TBNA for mediastinal and hilar lymph nodes. Methods: This retrospective study included patients who presented to our hospital between October 2022 and April 2024 with mediastinal or hilar lymph nodes of short diameter ≥ 1 cm on CT or abnormally increased lymph node metabolism on PET-CT and successively completed EBUS-TBNA and EBUS-TDB procedures. Results: Overall, 278 patients were included in the study, and 244 cases were confirmed. The diagnostic rates (p-values) of EBUS-TDB and EBUS-TBNA in pulmonary and extrapulmonary malignancies, lymphoma, sarcoidosis, and lymph node tuberculosis were 96.6% vs. 76.3% (0.043), 100% vs. 67.7% (−), 88.9% vs. 31.1% (0.555), and 69.2% vs. 30.8% (0.049), respectively. No serious adverse events occurred during or after the surgery. Conclusion: Contact laser-assisted EBUS-TBNB is superior to EBUS-TBNA for the diagnosis of mediastinal or hilar lymph nodes and may be used as an alternative to EBUS-TBNA.