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Background: Endobronchial Ultrasound (EBUS) has emerged as a crucial tool for diagnosing intrathoracic disorders, particularly in the staging of lung cancer. However, its diagnostic capabilities in the context of benign and rare diseases remain a subject of debate., Aim: to investigate the diagnostic yield and safety of EBUS-transbronchial mediastinal cryobiopsy (EBUS-TMC) in comparison to EBUS-transbronchial needle aspiration (TBNA) for a broad spectrum of intrathoracic diseases., Methods: a single-centre retrospective observational study conducted on 48 patients who underwent both EBUS-TBNA and endobronchial ultrasound-transbronchial mediastinal cryobiopsy (EBUS-TMC) in the same procedure between August 2021 and October 2023., Results: The overall diagnostic yield of EBUS-TMC surpassed that of EBUS-TBNA (95.8% vs 54.1 %), notably excelling in the diagnosis of sarcoidosis (92.8% vs 78.5 %), rare mediastinal disorders (100% vs 0 %), hyperplastic lymphadenopathy (100% vs 0 %), and lymphoproliferative disease (100% vs 0 %). No significant differences were observed in the diagnosis of NSCLC and SCLC. Samples obtained through EBUS-TMC facilitated the acquisition of NGS and immunohistochemical analyses more readily., Conclusion: EBUS-TMC may contribute to the precise diagnosis and subtyping of mediastinal diseases, especially lymphomas and rare mediastinal tumors, thereby reducing the number of non-diagnostic procedures., Competing Interests: Conflicts of interest None., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard approach for lung cancer staging. However, its diagnostic utility for other mediastinal diseases might be hampered by the limited tissue retrieved. Recent evidence suggests the novel sampling strategies of forceps biopsy and cryobiopsy as auxiliary techniques to EBUS-TBNA, considering their capacity for larger diagnostic samples., Methods: This study determined the added value of forceps biopsy and cryobiopsy for the diagnosis of mediastinal diseases. Consecutive patients with mediastinal lesions of 1 cm or more in the short axis were enrolled. Following completion of needle aspiration, three forceps biopsies and one cryobiopsy were performed in a randomised pattern. Primary endpoints included diagnostic yield defined as the percentage of patients for whom mediastinal biopsy led to a definite diagnosis, and procedure-related complications., Results: In total, 155 patients were recruited and randomly assigned. Supplementing EBUS-TBNA with either forceps biopsy or cryobiopsy increased diagnostic yield, with no significant difference between EBUS-TBNA plus forceps biopsy and EBUS-TBNA plus cryobiopsy (85.7 % versus 91.6 %, P = 0.106). Yet, samples obtained by additional cryobiopsies were more qualified for lung cancer molecular testing than those from forceps biopsies (100.0 % versus 89.5 %, P = 0.036). When compared directly, the overall diagnostic yield of cryobiopsy was superior to forceps biopsy (85.7 % versus 70.8 %, P = 0.001). Cryobiopsies produced greater samples in shorter procedural time than forceps biopsies. Two (1.3 %) cases of postprocedural pneumothorax were detected., Conclusions: Transbronchial mediastinal cryobiopsy might be a promising complementary tool to supplement traditional needle biopsy for increased diagnostic yield and tissue harvesting., Trial Registration: ChiCTR2000030373., Competing Interests: Declaration of Competing Interest Felix JF Herth received honoraria for advisory board activities and lecture fees from Pulmonx, Erbe, Olympus, and Uptake. All other authors declare no competing interests., (Copyright © 2023 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Mediastinal tubercular lymphadenitis is form of extrapulmonary tuberculosis [EPTB]. Clinical presentations are non-specific and diagnosis remains great clinical challenge. Microbiological and or histopathological evidences need to be present in order make diagnosis secure before initiation of anti-tubercular therapy (ATT). Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) provides tissue samples and aids management of this difficult to diagnosed entity. Current study describe role of EUS-FNA and Gene Xpert (GXP) in mediastinal tubercular lymphadenitis., Methods: Retrospective analysis of 72 patients with mediastinal lymphadenopathy who underwent EUS-FNA were carried out. Linear echoendoscope was used for evaluation mediastinum. EUS echo features of LNs were studied. Twenty two-G needle used was for aspiration tissue sample from pathologic lymph nodes (LNs). FNA samples were analysed by cytology, Acid-Fast Bacilli (AFB) staining and GXP study. All procedures were uneventful without any complications., Results: Forty two patients were diagnosed as tuberculosis (TB) following first EUS-FNA setting. Six patients underwent repeat EUS-FNA procedure following which another 3 were diagnosed as TB while remaining 3 started on empirical ATT based on additional supportive evidences. Forty five patients showed granulomatous inflammation on cytological analysis, AFB positivity noted in 16 (33.33%) patients while GXP in 26 (57.78%) patients. Rifampicin resistance detected in 3 ((6.25%) patients. All patients were followed clinico-radiologically for response to treatment., Conclusion: Tuberculous lymphadenitis is the most common cause of mediastinal lymphadenopathy in TB endemic countries. EUS-FNA provides microbiological and histopathological/cytological evidences in this difficult to diagnosed EPTB and thereby avoids empirical ATT., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the gold standard in the diagnosis of mediastinal and hilar lesions. For certain purposes, such as the diagnosis and subtyping of lymphoproliferative disorders or molecular pathology, a larger amount of intact sample material is required. EBUS cryobiopsy is a new and efficient tool for this purpose. As it is a new approach, there is still no standardised workflow. In this review, we present the procedure step by step as it is performed at the Ruhrlandklinik in Essen., Competing Interests: Büscher: keine Interessenkonflikte. Karpf-Wissel: Vortragshonorar und Veranstaltungsunterstützung von Olympus. Funke: Vortragshonorare von Olympus Deutschland GmbH, Broncus Medical Inc., Leufen Medical GmbH und Streamedup! GmbH. Darwiche: Referentenhonorare von Olympus, Boston Scientific, ErbeI, Storz; Honorare für Beratertätigkeit von Fujifilm, Olympus, Storz; Forschungsunterstützung von Ambu., (Thieme. All rights reserved.)

Background:  Mediastinal lymphadenopathies with high 18-fluorodeoxyglucose uptake in patients previously operated on for lung cancer are alarming for recurrence and necessitate invasive diagnostic procedures. Peroperative placement of oxidized cellulose to control minor bleeding may lead to a metastasis-like image through a foreign body reaction within the dissected mediastinal lymph node field at postoperative examinations. In this study, we investigated clinicopathological features and the frequency of foreign body reaction mimicking mediastinal lymph node metastasis., Methods:  Patients who underwent surgery for lung cancer between January 2016 and August 2021 and who were subsequently evaluated for mediastinal recurrence with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were included. Patients were grouped according to the results of EBUS-TBNA as metastasis, foreign body, and reactive. Clinicopathological features of these patients were compared and characteristics of patients in the foreign body group were scrutinized., Results:  EBUS-TBNA was performed on a total of 34 patients during their postoperative follow-up due to suspicion of mediastinal recurrence. EBUS-TBNA pathological workup revealed metastasis in 18 (52.9%), foreign body reaction in 10 (29.4%) and reactive lymph nodes in 6 (17.6%) patients. Mean maximum standardized uptake value (SUVMax) for metastasis group and foreign body group were 9.39 ± 4.69 and 5.48 ± 2.54, respectively ( p  = 0.022). Time interval between the operation and EBUS-TBNA for the metastasis group was 23.72 ± 10.48 months, while it was 14.90 ± 12.51 months in the foreign body group ( p  = 0.015)., Conclusion:  Foreign body reaction mimicking mediastinal lymph node metastasis is not uncommon. Iatrogenic cause of mediastinal lymphadenopathy is related to earlier presentation and lower SUVMax compared with metastatic lymphadenopathy., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Patients with mediastinal lymph node enlargement (MLNE) are diagnosed depending on lymph node biopsy. Whereas, how to obtain larger tissue masses from mediastinal lymph nodes and improve the diagnostic yield of the disease remains to be investigated., Objectives: Aiming to assess the diagnostic value of endobronchial ultrasound-guided intranodal forceps biopsy via transbronchial laser photoablation (EBUS-IFB-TLP) in patients with MLNE., Design: A prospective, self-controlled study., Methods: This study was conducted on 67 MLNE patients requiring a lymph node biopsy for diagnosis at the Henan Provincial People's Hospital and the Fuwai Central China Cardiovascular Hospital in China, from January 2020 to December 2022. Each patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA group) and EBUS-IFB-TLP (EBUS-IFB-TLP group) on the same mediastinal lymph node for biopsies. The operation time, diagnostic efficiency, and complication rates of the two biopsy methods were compared., Results: The number of diagnosed patients in the EBUS-IFB-TLP and the EBUS-TBNA groups was 65 (97.0%) and 57 (85.1%), respectively ( p  = 0.021). In the EBUS-IFB-TLP group, 28 cases (96.6%) were diagnosed with lung cancer and were classified into different epithelial types. In the EBUS-TBNA group, there were 27 cases (93.1%) diagnosed with lung cancer, of which 26 (89.7%) were classified into different epithelial types. There were 37 (97.4%) and 30 (78.9%) non-lung cancer patients diagnosed in the EBUS-IFB-TLP and EBUS-TBNA groups, respectively ( p  = 0.039), while 27 cases (96.4%) of sarcoidosis in the EBUS-IFB-TLP group and 20 cases (71.4%) of sarcoidosis in the EBUS-TBNA group were diagnosed ( p  = 0.016). The percentages of intraoperative mild to moderate bleeding complications were 23.9% (16/67) and 14.9% (10/67) in the EBUS-IFB-TLP and in the EBUS-TBNA groups, respectively ( p  = 0.109)., Conclusion: This study demonstrated that EBUS-IFB-TLP could be a feasible and effective method in the diagnosis of patients with MLNE, presenting an analogous safety profile compared with EBUS-TBNA. Further studies are needed to verify the diagnostic performance of EBUS-IFB-TLP for MLNE.

Introduction: Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions in recent studies. Current literature suggests that this procedure has greater diagnostic efficacy compared to conventional EBUS-TBNA. This systematic review and meta-analysis aimed to evaluate the diagnostic yield and complications associated with EBUS-TMC in comparison to EBUS-TBNA, thereby exploring the potential of this novel technique in enhancing the diagnostic utility for mediastinal lesions., Methods: A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed., Results: The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86-3.72; p < 0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis, and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p = 0.0006) and benign disorder (87.62% vs. 60.00%, p < 0.0001)., Conclusion: This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications., (© 2024 S. Karger AG, Basel.)

Background: Transbronchial mediastinal cryobiopsy is a novel sampling technique for mediastinal disease. Despite the possibility of lung cancer misdiagnosis, the improved diagnostic yield of this approach for non-lung-cancer lesions compared with standard endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) highlights its diagnostic potential as a complementary technique to conventional biopsy. We aimed to evaluate the safety profile and added value of the combined use of transbronchial mediastinal cryobiopsy and standard EBUS-TBNA for the diagnosis of mediastinal diseases., Methods: We conducted an open-label, randomised trial at three hospital sites in Europe and Asia. Eligible patients were aged 15 years or older, with at least one mediastinal lesion of 1 cm or longer in the short axis that required diagnostic bronchoscopy. Participants were randomly assigned (1:1) using a block randomisation scheme generated by a computer (block size of four participants based on a random table from an independent statistician) to the combined use of EBUS-TBNA and transbronchial mediastinal cryobiopsy (combined group) or EBUS-TBNA alone (control group). Because of the nature of the intervention, neither participants nor investigators were masked to group assignment. The coprimary outcomes were differences in procedure-related complications and diagnostic yield (defined as the proportion of participants for whom mediastinal biopsy led to a definitive diagnosis), assessed in the full analysis set, including all the patients who met the eligibility criteria and had a biopsy. A fully paired, intraindividual diagnostic analysis in participants who had both needle aspiration and mediastinal cryobiopsy was conducted, in addition to interindividual comparisons. This trial is now complete and is registered with ClinicalTrials.gov, NCT04572984., Findings: Between Oct 12, 2020, and Sept 9, 2021, 297 consecutive patients were assessed for eligibility and 271 were enrolled and randomly assigned to the combined group (n=136) or the control group (n=135). The addition of cryobiopsy to standard sampling significantly increased the overall diagnostic yield for mediastinal lesions, as shown by both interindividual (126 [93%] of 136 participants in the combined group vs 109 [81%] of 135 in the control group; risk ratio [RR] 1·15 [95% CI 1·04-1·26]; p=0·0039) and intraindividual (126 [94%] of 134 vs 110 [82%] of 134; RR 1·15 [95% CI 1·05-1·25]; p=0·0026) analyses. In subgroup analyses in the intraindividual population, diagnostic yields were similar for mediastinal metastasis (68 [99%] of 69 participants in the combined group vs 68 [99%] of 69 in the control group; RR 1·00 [95% CI 0·96-1·04]; p=1·00), whereas the combined approach was more sensitive than standard needle aspiration in benign disorders (45 [94%] of 48 vs 32 [67%] of 48; RR 1·41 [95% CI 1·14-1·74]; p=0·0009). The combined approach also resulted in an improved suitability of tissue samples for molecular and immunological analyses of non-small-cell lung cancer. The incidence of adverse events related to the biopsy procedure did not differ between trial groups, as grade 3-4 airway bleeding occurred in three (2%) patients in the combined group and two (1%) in the control group (RR 0·67 [95% CI 0·11-3·96]; p=1·00). There were no severe complications causing death or disability., Interpretation: The addition of mediastinal cryobiopsy to standard EBUS-TBNA resulted in a significant improvement in diagnostic yield for mediastinal lesions, with a good safety profile. These data suggest that this combined approach is a valid first-line diagnostic tool for mediastinal diseases., Funding: National Natural Science Foundation of China., Competing Interests: Declaration of interests FJFH reports honoraria for advisory board activities and lecture fees from Pulmonx, Erbe, Olympus, and Uptake. WMK received honoraria for advisory board activities, consultancies, and lectures from Roche Diagnostics International and Bayer Aktiengesellschaft. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Ultrasonographic characteristics may help differentiate between benign and malignant lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). There is limited data on the utility of various ultrasonographic lymph node features to differentiate between malignant and tuberculous mediastinal lymphadenopathy., Methods: We studied the various EBUS ultrasonographic lymph node characteristics (size, shape, margins, heterogeneous echotexture, calcification, central hilar structure, lymph node conglomeration, central intranodal vessel, and coagulation necrosis sign) from our available EBUS-TBNA database., Results: We extracted 1086 subjects [547 with tuberculosis (TB) and 539 with malignant diagnosis]. Comparing the 2 groups (multivariate analysis), presence of central hilar structure (8.2% vs. 2.6%), coagulation necrosis sign (37.5% vs. 13.7%), lymph node conglomeration (30.5% vs. 7.2%), calcification (5.1% vs. 1.5%), and distinct margins (83.5% vs. 69.8%), were significantly more common in TB ( P <0.05). On the other hand, malignant lymph nodes were larger and more likely to show the presence of a central intranodal vessel (20% vs. 15.8%, P =0.04, multivariate analysis). The absence of lymph node conglomeration had the highest overall diagnostic accuracy (0.61) for the differentiation between malignant and tuberculous lymph nodes., Conclusion: Sonographic lymph node characteristics may help differentiate malignant and tuberculous mediastinal lymphadenopathy. Contrary to previously published literature, we observed coagulation necrosis sign, heterogeneous echotexture and absent central intranodal vessel, more commonly in TB than malignant nodes. These findings from a TB endemic setting are different from other settings, where the prevalence of lung cancer is high in patients undergoing EBUS-TBNA., Competing Interests: Disclosure: There is no conflict of interest or other disclosures., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to evaluate mediastinal lymphadenopathy. Studies focusing on malignant lymphadenopathy have compared 21- and 22-gauge (21G and 22G, respectively) needles and have not identified an advantage of one needle size over the other in terms of diagnostic yield., Research Question: Does the 19-gauge (19G) EBUS needle offer greater diagnostic yield and sensitivity vs the 21G and 22G EBUS needles for a diagnosis of sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed?, Study Design and Methods: This study retrospectively examined records of 730 patients from the Stather Canadian Outcomes Registry for Chest Procedures (SCOPE) database who underwent EBUS-TBNA for a diagnosis of suspected sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed. A propensity score analysis of two groups was performed. One group comprised patients undergoing EBUS-TBNA with a 19G needle, the other with a 21G or 22G needle. Cases for analysis were selected with a 1:2 ratio of 19G vs 21/22G using logistic regression and random matching with all eligible 19G cases included., Results: There were 137 patients (312 targets) in the 19G group and 274 patients (631 targets) in the 21/22G group in the propensity score analysis. The diagnostic yield was 107 of 137 (78.1%) in the 19G group vs 194 of 274 (70.8%) in the 21/22G group (difference, 7.3%; 95% CI, -1.9 to 15.6; P = .116). The sensitivity of EBUS-TBNA for sarcoidosis was 80 of 83 (96.4%) in the 19G group vs 150 of 156 (96.2%) in the 21/22G group (difference, 0.24%; 95% CI, -6.6 to 85.1; P = .93). In patients with a final diagnosis of lymphoma, EBUS was diagnostic in 10 of 13 (76.9%) in the 19G group vs 12 of 12 (100%) in the 21/22G group (difference, 23.1%; 95% CI, -5.4 to 50.3; P = .08)., Interpretation: The study did not identify an advantage of the 19G EBUS needle over the 21/22G EBUS needles for diagnostic yield nor sensitivity for sarcoidosis or lymphoma., (Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool for precise diagnosis of thoracic lesions. However, the procedure sometimes has a poor yield. Rapid on-site evaluation (ROSE) in EBUS-TBNA has been shown to be helpful to improve its diagnostic yield and minimise the need for repeat procedures. Most of the studies that have evaluated the utility of ROSE have focused on malignant lesions; however, it is important to understand its utility in benign lesions, particularly in a country with a high tuberculosis burden., Objective: This study was undertaken to evaluate the utility of ROSE in EBUS-TBNA for the diagnosis of patients presenting with mediastinal lymphadenopathy and/or thoracic mass for benign and malignant pathologies., Methods: This was a prospective study including 47 patients who underwent EBUS-TBNA for thoracic lesions (lung masses and hilar/mediastinal lymphadenopathy) over a 10-month period at a single tertiary care centre. In addition to ROSE and definitive cytology, the aspirated material was also sent for cell block and microbiological studies. Endobronchial/transthoracic biopsy was conducted for histopathological evaluation (HPE) where required, at the discretion of the clinician. ROSE diagnosis was then compared with the final diagnosis., Results: Of the 47 patients examined using ROSE, granulomas were observed in 33 cases, non-specific inflammation in six cases, and malignancy in five cases; one case was inconclusive and the sample was found to be inadequate in two cases. The ROSE assessment matched the final diagnosis in 84.45% patients., Conclusion: ROSE is a simple procedure that is able to provide an immediate and accurate assessment of adequacy and has a significant yield, enabling a preliminary diagnosis to be made in both benign and malignant samples., (© 2021 John Wiley & Sons Ltd.)

Background: Lung cancer is the second most common cancer in both men and women. Mediastinal lymph node involvement in these patients, determined by imaging tests, indicates prognosis and modifies therapeutic attitude., Purpose: The aim of this study was to analyze the diagnostic capacity of magnetic resonance imaging (MRI) in the study of the mediastinum in comparison with conventional tests (computed tomography [CT] and positron-emission tomography [PET] or PET/CT scans), taking histology as the gold standard., Materials and Methods: An observational study was conducted on 16 patients with suspicion of primary lung cancer (June 2016 through December 2018). We studied their demographic characteristics and used CT, PET, or PET/CT scans and MRI (diffusion-weighted imaging-MRI sequence) to examine mediastinal disease and compare MRIs diagnostic yield and percentage agreement to that of conventional tests., Results: As compared to CT and PET scanning, MRI displayed a very low sensitivity and a specificity of 90 and 88%, respectively; positive predictive value was 0.67 (both) and negative predictive value (NPV) was 0.28 and 0.22, respectively. MRI showed a high degree of agreement in lymph node diagnosis when compared with histology (91.2%; P = 0.001): specificity in this case was high (E = 0.94), as was the NPV (NPV = 0.97)., Conclusions: The results of this study would appear to indicate that MRI could play a relevant role in mediastinal staging of lung cancer. More prospective, multicenter studies are, however, needed to be able to draw up firm recommendations about the role of MRI and its place in lung cancer staging., Competing Interests: None

Background: Video-assisted mediastinoscopy (VAM) is a valuable method in the investigation of diseases with mediastinal lymphadenopathy or those localized in the mediastinum. The aim of this study was to determine the diagnostic value of VAM in the investigation of mediastinal involvement of nonlung cancer diseases and to describe our institutional surgical experience., Methods: Clinical parameters such as age, sex, histological diagnosis, morbidity, and mortality of all patients who underwent VAM for the investigation of mediastinal involvement of diseases except lung cancer between January 2006 and July 2018 were retrospectively reviewed, and the diagnostic efficacy of VAM was determined statistically., Results: During the study period, 388 patients underwent VAM, and 536 lymph nodes were sampled for histopathological evaluation of mediastinum due to mediastinal lymphadenopathy or paratracheal lesions. The most common diagnoses were sarcoidosis ( n  = 178 [45.9%]), tuberculous lymphadenitis ( n  = 108 [27.8%]), lymphadenitis with anthracosis ( n  = 72 [18.6%]), and lymphoma ( n  = 15 [3.9%])., Conclusion: The results of the study show that VAM should be used because of its high diagnostic benefit in mediastinal lymphadenopathies, which are difficult to diagnose, or mediastinal lesions located in the paratracheal region. Despite the increase in the number of new diagnostic modalities, VAM is still the most effective method and a gold standard., Competing Interests: None declared., (Thieme. All rights reserved.)

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is routinely performed for diagnostic evaluation of mediastinal lymphadenopathy due to various etiologies with excellent sensitivity and specificity. Melioidosis can have atypical features like isolated mediastinal lymphadenopathy mimicking as tuberculosis or lymphoma. Differentiation of such atypical melioidosis presentation become difficult due to similar clinical, radiological and even similar EBUS lymph node characteristics. Role of EBUS TBNA in diagnosing melioidosis is under investigated and sparsely reported. We describe two cases of melioidosis diagnosed by point of care rapid lateral flow immunoassay antigen testing and culture of EBUS-TBNA samples from necrotic mediastinal lymph nodes.

Competing Interests: Competing interests: None declared.

Aim: To investigate the characteristics and clinical value of chest computed tomography (CT) images of novel coronavirus pneumonia (NCP)., Materials and Methods: Clinical data and CT images of 80 cases of NCP were collected. The clinical manifestations and laboratory test results of the patients were analysed. The lesions in each lung segment of the patient's chest CT images were characterised. Lesions were scored according to length and diffusivity., Results: The main clinical manifestations were fever, dry cough, fatigue, a little white sputum, or diarrhoea. A total of 1,702 scored lesions were found in the first chest CT images of 80 patients. The lesions were located mainly in the subpleural area of the lungs (92.4%). Most of the lesions were ground-glass opacity, and subsequent fusions could increase in range and spread mainly in the subpleural area. Pulmonary consolidation accounted for 44.1% of all of the lesions. Of the 80 cases, 76 patients (95%) had bilateral lung disease, four (5%) patients had unilateral lung disease, and eight (10%) patients had cord shadow., Conclusion: The chest CT of NCP patients is characterised by the onset of bilateral ground-glass lesions located in the subpleural area of the lung, and progressive lesions that result in consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have inflammatory changes in the lungs alongside a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect., (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Magnetic resonance imaging (MRI) of the abdomen may include lower chest findings which may be overlooked or misinterpreted due to their location outside the area of main exam focus or lack of familiarity with the image appearance of these findings. This article will review the utility of abdominal MRI sequences to diagnose lower chest pathology while providing a systematic pictorial review of imaging findings in the lungs, pleura, mediastinum and chest wall. We will discuss the MRI appearance of lung nodules and masses, lung infiltrates, pulmonary infarction, pulmonary embolism, empyema, pleural effusions and thickening, mediastinal lesions and lymphadenopathy, cardiac thrombus and masses, and breast lesions. The purpose of this article is to increase awareness to the diagnostic advantages of abdominal MRI sequences for lower chest findings and encourage abdominal MRI readers to meticulous scrutinize the lower chest for concomitant pathology., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Endobronchial ultrasound with transbronchial needle aspiration (TBNA) is commonly performed for the evaluation of mediastinal lymphadenopathy. Purulent pericarditis is a rare, yet potentially fatal complication of TBNA. It commonly presents with nonspecific symptoms such as chest pain, shortness of breath, palpitations, or vague abdominal discomfort. Additionally, more severe symptoms such as cardiac tamponade and even death have been reported. In this article, we present the case of a 58-year-old male who developed purulent pericardial effusion with tamponade thought to be caused by TBNA cytology. This case raises an important question regarding the current guidelines for prophylactic antibiotic treatment for patients at high risk of developing purulent pericarditis as a complication of TBNA.

Rosai-Dorfman disease (RDD) is a rare benign disorder of the histiocytes, affecting lymph nodes in its classic form. Extranodal RDD is considered the uncommon subtype and potentially impairs all tissues and intrathoracic organs. In our report, a 18 F-fluorodeoxyglucose positron emission tomography scan of a mediastinal mass infiltrating the lungs and of widespread lesions suggested the presence of a metastatic disease. Open thoracic biopsy was required for immunochemistry and histopathology. Mediastinal mass with lesions disseminated throughout the body is an unusual presentation of extranodal RDD that calls for a challenging differential diagnosis to rule out the suspicion of metastatic malignancy., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background/purpose: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been gradually introduced in the diagnosis of mediastinal tuberculous (TB) lymphadenitis. The purposes of this study were to evaluate the utility of polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) using EBUS-TBNA rinse fluid and to explore the factors that influence the accuracy of EBUS-TBNA., Methods: A retrospective study with prospective data collection was carried out with patients with unselected mediastinal lymphadenopathy who underwent EBUS-TBNA and a TB-PCR study from April 2010 to July 2017. Patients without TB were excluded. The diagnostic accuracy rate for each diagnostic modality (pathology, smear, culture, and TB-PCR) was calculated respectively. The characteristics of the lymph node (LN) and the pathologic findings were analyzed as possible impact factors., Results: 240 consecutive patients who received EBUS-TBNA were enrolled, and in the end, 21 patients with a diagnosis of TB lymphadenitis were included. When combined with histologic results and traditional microbiologic studies, the diagnostic accuracy of EBUS-TBNA was 57.1%. If TB-PCR was also utilized, the diagnostic accuracy would significantly increase to 71.4% (p < 0.001). Univariate and multivariate regression analysis revealed that pathology showing necrosis had a higher positive microbiologic result when using EBUS-TBNA rinse fluid., Conclusion: EBUS-TBNA is a valuable tool for diagnosis of mediastinal TB lymphadenitis. Using TB-PCR assay and targeting LNs with a necrotic component would improve the diagnostic performance of EBUS-TBNA., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a reliable technique providing high diagnostic yield in mediastinal lymphadenopathy. However, mediastinoscopy is sometimes necessary to eliminate false-negative results. Elastography is a recent technique that can be combined with EBUS to evaluate the elasticity and consequently the nature of a tissue. The primary objective was to evaluate the diagnostic performance of EBUS-TBNA combined with elastography for the assessment of mediastinal lymph nodes., Methods: Single-center, prospective study in patients with mediastinal lymphadenopathy. EBUS-TBNA combined with elastography was performed in each patient. Several elastographic parameters were studied: colorimetric score, average elasticity, elasticity ratio, percentage of hard areas. The final diagnosis was that obtained by TBNA cytology, histology of a surgical biopsy, when performed, or follow-up CT and PET-CT at 6 months., Results: Overall, 110 lymph nodes were examined in 87 patients: 44 were malignant according to TBNA. These nodes had significantly higher elasticity ratio, percentage of hard areas and colorimetric score and significantly lower average elasticity compared to benign nodes (P<0.001). With a negative predictive value of 100%, the cut-offs defined by receiver operating characteristic curves were 1.4 for elasticity ratio, 84.8 for average elasticity, 32.6 for percentage of hard areas and 3 for colorimetric score. No adverse events were observed., Conclusion: Endobronchial ultrasound elastography is a non-invasive technique that can contribute to prediction of the nature of lymph nodes by distinguishing malignant from benign nodes. Although EBUS cannot replace histological examination, elastography can provide reliable complementary information when combined with EBUS., (Copyright © 2019 SPLF and Elsevier Masson SAS. All rights reserved.)

Background: With recent advances of biological disease-modifying antirheumatic drugs, chest CT has been increasingly performed in rheumatoid arthritis (RA) patients, and mediastinal/axillar lymphadenopathy is being detected., Purpose: To determine the prevalence of mediastinal and axillar lymph node enlargements on chest CT in RA patients at the initial diagnosis, and to assess its clinical significance., Material and Methods: We retrospectively reviewed the medical records and chest CT findings of 78 consecutive RA patients. The short axis of the most enlarged lymph nodes (SLN) on CT was measured for the mediastinal and axillar regions separately. The SLN was classified into two groups: Group 1, 10 mm or less; and Group 2, larger than 10 mm., Results: Group 2 was observed in 13 of 78 patients (17%) for the mediastinum, and in 29 (37%) for the axilla; 11 patients (14%) showed Group 2 for both regions. The Group 2 patients (n = 31), either mediastinum or axilla, showed significantly higher simple disease activity index (SDAI) (mean, 36.0) than the patients of Group 1 (n = 47; mean SDAI, 23.0) (p < 0.001). For the mediastinal SLN, the RA-related lung disease was more frequently observed in the Group 2 patients than in the Group 1 (p = 0.036)., Conclusion: The mediastinal and/or axillar lymphadenopathy on chest CT may reflect the activity of RA. The mediastinal lymphadenopathy also seems to relate to the RA-related lung disease., (Copyright © 2019. Published by Elsevier Inc.)

Boerhaave syndrome is a transmural disruption of the esophagus, due to an increase in esophageal pressure and is associated with high morbidity and mortality. There are cases reported secondary to bowel obstructions such as incarcerated hernias and gallstone ileus. Here, we describe an unusual autopsy case of Boerhaave syndrome, due to bowel obstruction secondary to biliary adenocarcinoma, which has never been reported in the literature. The patient was an 87-year old male presenting with severe chest and epigastric pain. Computed tomography showed fluid-filled esophagus, gastric distention and an ill-defined mass within the liver. Patient underwent esophagogastroduodenoscopy, which revealed esophageal rupture. Patient expired within 20 hours of admission. On autopsy, the decedent was found to have an esophageal perforation and an inferior hepatic mass, which morphologically and immunohistochemically was consistent with a biliary adenocarcinoma., (© 2019 by the Association of Clinical Scientists, Inc.)

Introduction: Various cell block (CB) preparation methods are utilized by different laboratories, and not all laboratories perform CBs in tandem with ThinPreps (TPs). To compare the performance of different CB methods and their diagnostic value when used in conjunction with TP, we assessed the quantity and size of granulomas obtained from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of lymph nodes in the evaluation of granulomatous mediastinal disease., Materials and Methods: A retrospective analysis of mediastinal lymph node EBUS-TBNA specimens that detected granulomas at our institution was performed. A total of 264 specimens from 124 patients had a TP followed by a CB (either plasma-thrombin, HistoGel, or CellGel) prepared from the residual material in the PreservCyt vial. The number and size of granulomas on each preparation was assessed using digital software., Results: Granulomas were detected only on the CB in 18.9% of cases and only on the TP in 5.3%. All 3 CB preparation methods showed significantly more and larger granulomas compared with the paired TP, with the plasma-thrombin and CellGel methods yielding more diagnostic material than the HistoGel method. In addition, the average number of granulomas (4.0 ± 0.4 versus 15.3 ± 1.1) and granuloma size (119.2 ± 3.2 μm versus 271.8 ± 7.3 μm) were significantly lower on TP compared with CB, respectively., Conclusions: Plasma-thrombin and CellGel CB preparation methods had a higher granuloma yield compared with the HistoGel method. Additionally, significantly more numerous and larger granulomas were present on CBs compared with TP slides. Therefore, solely relying on TP slide evaluation may unintentionally overlook larger tissue fragments obtained during needle aspirations., (Copyright © 2018 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Neurofibromatosis type 1 (NF1) is a multisystem phakomatosis. The intrathoracic manifestations of NF1 are protean. We describe a rare case of a plexiform neurofibroma infiltrating the mediastinum and lungs with multiple endobronchial neurofibromata. To our knowledge, a mediastinal plexiform neurofibroma extending into the lungs on CT has not been reported., (© 2018 The Royal Australian and New Zealand College of Radiologists.)

Competing Interests: Competing interests: None declared.

Introduction: Diffusion weighted imaging (DWI) has shown its potential as a reliable noninvasive technique for tissue characterization. DWI reflects the tissue specific diffusion capacity which can be used for tissue characterization. Hypercellular tissue (e.g; malignant tumors) had restricted diffusion capacity with increased signals on DWI and low ADC values. Non-tumoral tissues show low cellularity, and diffusion capacity is not restricted resulting in signal loss on DWI and high apparent diffusion coefficient (ADC). Differential diagnosis of mediastinal lymphadenopathy is an issue of debate, especially in malignant benign differentiation. Diffusion weighted imaging with magnetic resonance could improve the diagnostic accuracy in differentiation between benign and malignant mediastinal nodes., Objectives: to determine the efficacy of diffusion weighted MRI in evaluation of mediastinal lymphadenopathy with histopathological correlation to differentiate benign from malignant lymph nodes., Material and Methods: 30 patients with mediastinal lymphadenopathy underwent diffusion weighted MRI. ADCs of lymph nodes were derived and constructed from b = 0 and b = 1000 sec/mm2 values by drawing regions of interests (ROI). Consequently, mediastinal nodes were studied, biopsies and histopathological analysis were done after MRI examination., Results: The best cutoff point of ADC to differentiate benign from malignant lesions was 1.15 mm/sec (sensitivity 77%, specificity 92% and AUC 81.4%). Significant negative correlation of ADC by DW MRI and the size of the LNs. The mean ADC values in the lymphoma group was lower than in the sarcoidosis group, and the difference was statistically significant., Conclusion: The study supports that MRI with diffusion weighted images can differentiate benign from malignant mediastinal lymphadenopathy and differentiate lymphoma from sarcoidosis non-invasively.

TAFRO syndrome, a rare systemic inflammatory disease, can lead to multiorgan failure without appropriate treatment. Although thrombocytopenia is frequently seen in patients with TAFRO syndrome, little is known about its pathogenesis. Moreover, while recent studies have reported the presence of an anterior mediastinal mass in some patients, the pathological status of this remains unclear. Here, we report a case of fatal bleeding in a patient with TAFRO syndrome accompanied by an anterior mediastinal mass. A 55-year-old female was transferred to our hospital with a 2-week history of fever, epistaxis, and dyspnea. Laboratory tests revealed severe thrombocytopenia, computed tomography (CT) showed pleural effusions, and bone marrow biopsy revealed reticulin myelofibrosis. We suspected TAFRO syndrome, but the CT scan showed an anterior mediastinal mass that required a biopsy to exclude malignancy. She soon developed severe hemorrhagic diathesis and died of intracranial hemorrhage despite intensive treatment. She had multiple autoantibodies against platelets, which caused platelet destruction. An autopsy of the mediastinal mass revealed fibrous thymus tissues with infiltration by plasma cells. Our case suggests that thrombocytopenia could be attributed to antibody-mediated destruction and could be lethal. Hence, immediate treatment is imperative in cases of severe thrombocytopenia, even when accompanied by an anterior mediastinal mass., (© 2019 S. Karger AG, Basel.)

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is recommended for the diagnosis of mediastinal lymph nodes by the American College of Chest Physicians guidelines; however, the guidelines state that this procedure should only be performed by a trained bronchoscopist. Complications related to needle malfunction during the EBUS-TBNA procedure have recently been reported. We herein describe a rare case involving the successful management of a needle breakage that occurred as an unusual complication of EBUS-TBNA. An 81-year-old male patient with a medical history of myocardial infarction was introduced to our institution to undergo an evaluation for mediastinal and right hilar lymphadenopathy on chest computed tomography (CT). We performed EBUS-TBNA in a 14×10 mm subcarinal lymph node station using a 22 G aspiration needle (NA-201SX-4022, Vizishot®, Olympus, Japan) for diagnosing and staging of the patient's lung cancer. After the second aspiration, we noticed that the needle tip was broken and that it was stuck in the right main bronchus. We immediately removed the broken needle tip from the right main bronchus by flexible bronchoscopy using an ID 8.5 mm tracheal tube without cuff inflation. The length of the needle tip was 13 mm and it was considerably bent. The EBUS scope did not suffer any apparent damage. The patient did not have any other procedure-related complications. Needle breakage during EBUS-TBNA is rare; however, inhaling or swallowing of a broken needle tip has the potential to cause serious complications. Bronchoscopists should therefore be aware of the possibility of needle breakage, which is an important complication during EBUS-TBNA.

Amyloidosis is a unique disease of localised or systemic deposition of the abnormal extracellular fibril. Localised amyloidosis generally takes a benign course, while systemic requires treatment. Adenopathy, especially mediastinal adenopathy, is an unusual manifestation of localised amyloidosis and often requires mediastinoscopy or surgical resection for diagnosis. With the advent of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), there is potential for a less invasive diagnostic approach. We report a rare case of localised mediastinal amyloidosis diagnosed by EBUS-TBNA., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Rationale: Spontaneous esophageal rupture (Boerhaave syndrome) is a rare, though frequently fatal, event. It is generally caused by a sudden increase in pressure inside the esophagus. In some cases, full-thickness perforations of the esophagus may develop from previous lesions that initially involve only the esophageal mucosa (Mallory-Weiss syndrome) and which, following further triggering events, give rise to a transmural lesion., Patient Concerns: Here, we present the case of a 45-year-old subject who suddenly died of acute cardio-respiratory failure, an autopsy was performed to identify the cause of death., Diagnosis, Interventions, and Outcomes: The autopsy examination revealed a full-thickness rupture of the esophageal wall. Through the integration of necroscopy findings, anamnestic data, and histopathological examination, it has been possible to establish that complete esophageal rupture resulted from the evolution of a previous partial lesion of the esophageal wall, and that an untreated Mallory-Weiss syndrome evolved into a rapidly fatal Boerhaave syndrome., Lessons: This case shows that distal esophageal tears, rather than constituting a distinct entity, may be part of a spectrum of diseases and that a partial lesion of the esophageal wall caused by barogenic injury may evolve into a full-thickness rupture following further barotraumas.

Introduction: Immune checkpoint inhibitors are becoming a standard treatment for many different cancers. Their toxicities are variable and include organ-specific dysimmune injuries and the development of systemic diseases., Case Report: We report 3 cases of sarcoid-like granulomatosis that occurred during treatment of various types of primary cancer by immune checkpoint inhibitors: lung adenocarcinoma, small cell lung cancer and melanoma. The clinical presentation, radiologic pattern and severity of this toxicity were variable. The diagnosis was made on biopsy with pathological examination and exclusion of differential diagnoses, particularly infection. In such cases, immunotherapy should be discontinued and subsequent rechallenge discussed later. Systemic corticosteroids should be considered depending on the severity of symptoms., Conclusions: Knowledge of this toxicity is crucial as the clinical signs and radiological patterns may suggest tumour progression., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Hemoptysis is a rare complication of acute aortic dissection. A 77-year-old woman was admitted to our department with epigastralgia and hemoptysis. Computed tomography showed Stanford A acute aortic dissection and massive posterior mediastinal hematoma which extended along the right pulmonary artery. Hemoptysis is a lethal sign of aortic dissection, therefore, emergency ascending aortic replacement was performed with a good clinical outcome.

Introduction: The aim of our study was to assess the interest of cervical mediastinoscopy in the management of benign mediastinal lymphadenopathy., Method: We performed a single-center retrospective descriptive study over a period of 5 years (2013-2017) in the department of thoracic surgery of university hospital Hassan II of Fez., Results: During this period, a total of 137 cervical mediastinoscopies were performed among which 68 for a benign disease. This represents a frequency of 49.63 %. There were 22 men and 46 women with a mean age of 43.76 years±17.08. Chest CT showed isolated mediastinal lymphadenopathy in 52 %, associated with pulmonary images in 35 %. Cervical mediastinoscopy led to pathological diagnosis in 94 %. The pathological results showed a sarcoidosis in 51.5 %, tuberculosis in 41.2 % and a lymph node echinococcosis in 1 case., Conclusion: Cervical mediastinoscopy remains a low risk modality in expert hands, which allows pathological diagnosis with excellent sensitivity, acceptable morbidity and no mortality in our experience., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) has proven to be an effective and minimally invasive tool to diagnose and stage lung cancer. However, its use for the diagnosis of rare mediastinal and lung pathologies has been rarely described. Hereby we describe a retrospective chart review of our EBUS-TBNA database for unusual diagnosis made between July 2012 and October 2016. Those conditions considered unusual for EBUS-TBNA diagnosis were identified and their medical records reviewed., (Copyright © 2018 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Enlarged lymph nodes or mediastinal masses diagnosed by computed tomographic scan before the advent of bronchoscopic procedures (TBNA or EBUS) were usually investigated using a thoracic surgical approach. In this paper, we report the experience with the use of a modified rigid tru-cut needle in the bioptical approach to mediastinal masses; to determine whether it could be considered a valid alternative to surgery, we investigated the diagnostic accuracy of this new endoscopic technique., Methods: A total of 156 selected patients with radiographic evidence of lymphadenopathy or mediastinal masses (subcarinal and paratracheal with a short-axis diameter >3 cm) were studied in our center by rigid bronchoscopy using a 18-G tru-cut needle to obtain a core biopsy of the lesion., Results: In 140 of 156 cases (89.7%), a histologically correct diagnosis was reached without perioperative or postoperative complications. A total of 114 (81.4%) malignant and 26 (18.6%) benign lesions were diagnosed avoiding further invasive surgical approach., Conclusions: Our results confirm that, in selected cases, transbronchial rigid core biopsy could be considered a safe and valid alternative technique to more invasive surgical approach in the diagnosis of mediastinal diseases.

Objective: To describe the results of endobronchial ultrasound-guided transbronchial needle aspiration in making diagnosis of mediastinal injuries associated to different causes., Methods: A retrospective cross-sectional study of patients submitted to Endobronchial ultrasound-guided transbronchial needle aspiration at a private organization, between June 2013 and October 2016. All cases referred for collection of lymph nodes or peritracheal/peribronchial masses by endobronchial ultrasound-guided transbronchial needle aspiration, and evaluated through tomography or PET-CT were included. Interventional pulmonologists and thoracic surgeons with experience in the method did the procedures. Rapid on-site evaluation of fine needle aspiration was performed by an experienced pathologist. Material analysis included cytological smear and cytopathological analysis of paraffin-embedded cell blocks. Other specific analyses (immunocytochemistry, tests and cultures of infectious agents) were performed whenever necessary., Results: We included 72 patients; 6 were excluded for presenting endobronchial lesions in which bronchoscopic biopsy could be performed, or intrathoracic lesions that were not accessible by endobronchial ultrasound-guided transbronchial needle aspiration. The mean age of 66 patients included for analysis was 61.17 years (±14.67 years), with a predominance of males (64%). Endobronchial ultrasound-guided transbronchial needle aspiration was definitive for diagnosis in 60 cases (91%). Three cases (4.5%) had inconclusive test results. There were no major complications related to the procedure., Conclusion: Endobronchial ultrasound-guided transbronchial needle aspiration had a high diagnosis yield, with minimal morbidity, being an excellent option for diagnostic approach of patients with lymphadenopathy or intrathoracic lesions, and for neoplasm staging.

Background: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) has revolutionized the diagnostic approach to mediastinal diseases. Lesions located lateral to the pulmonary artery (trans-PA, Station 5), or in the lumen of the PA (intra-PA) are in the 'blind-spot' of EBUS., Objectives: We describe a case series where EBUS guided trans-pulmonary or intra-pulmonary aspiration (EBUS-TIPNA) was used for diagnosis., Methods: Retrospective analysis of 10 patients who had EBUS-TIPNA over 3 years in 2 centres. The inclusion criteria included patients with station 5 lesions, or intrapulmonary artery lesions, where no other option was possible., Results: The study included 4 males and 6 females, mean age 52 years, with 7 trans-PA and 3 intra-PA lesions. Adequacy was seen in 10/10, and a definitive diagnosis was made in 9/10 patients. There were no procedure-related complications., Conclusion: EBUS-TIPNA can be done as a safe and successful procedure and adds to the armamentarium of Convex Probe-EBUS (CP-EBUS), in carefully selected patients., (© 2018 John Wiley & Sons Ltd.)