1) EBUS-TBNA (Endobronchial Ultrasound-Guided Fine Needle Aspiration)

Indications

• Diagnosis and staging of lung cancer

• Evaluation of mediastinal lymphadenopathy (e.g., TB, sarcoidosis, lymphoma)

• Sampling paratracheal, subcarinal, hilar, and interlobar lymph nodes

• Patients with poor peripheral perfusion

Advantages

• Real-time guidance increases accuracy.

• Minimally invasive alternative to mediastinoscopy.

• Can obtain diagnostic material in lung cancer, sarcoidosis, TB, lymphoma.

2. EBUS-Guided Cryobiopsy from Lymph Nodes

This is an emerging technique combining EBUS with transbronchial cryobiopsy, primarily in specialized centers.

Purpose

• To obtain larger and more preserved tissue samples than FNAC or conventional TBNA

• Better for lymphoma, sarcoidosis, or any condition needing preserved architecture

Advantages

• Larger, architecturally intact samples

• Higher diagnostic yield in lymphoma and granulomatous diseases

• Potentially better for molecular studies and IHC

Conclusion

• EBUS-FNAC remains the first-line for most diagnostic needs involving lymph nodes.

• EBUS-guided cryobiopsy is a promising adjunct in cases where FNAC is non-diagnostic or tissue architecture is critical (e.g., lymphoma).

• Both require proper planning, expertise, and post-procedure monitoring.