Diagnostic and Molecular Yield of a Multidisciplinary Team-Guided Combined Endobronchial and Endoscopic Ultrasound-Guided Sampling Strategy for Mediastinal and Hilar Lymphadenopathy.

Authors

Ahmed Abdelsamad, Essa Alghunaim, Mahmoud Mokhtar, Hossam Zaglouol, Essam Sabry, Talal Al Saeed, Reem Alhajri, Nusaiba Alrefae, Kaushik Majumdar, Tahani AlBaqer, Amir A Ahmed, Dherar Alshehab, Adel Ayed, Mohammad I Ghanbar, Sulaiman Khadadah

Published in

Journal of bronchology & interventional pulmonology. Volume 33. Issue 4. Oct 01, 2026. Epub Sep 03, 2026.

Abstract

Real-world data examining structured modality selection for mediastinal/hilar adenopathy in mixed malignant and benign cohorts is limited. We evaluated the performance of a multidisciplinary team (MDT)-guided strategy incorporating EBUS/EUS-B and EUS for both benign and malignant disease.
We conducted a retrospective study, including consecutive adults undergoing mediastinal/hilar lymph node sampling by endoscopy after MDT discussion. All cases were discussed at a dedicated thoracic MDT before the procedure, where the indication for sampling and the modality were predetermined based on anatomic accessibility on CT/PET-CT, clinical data, and anticipated tissue requirements. The primary outcome was diagnostic yield, defined as the proportion of procedures providing a definitive pathologic diagnosis consistent with the clinical and radiologic context, with concordance for benign diagnoses confirmed by a minimum of 3 months of clinical and radiologic follow-up. Secondary outcomes included yield by indication, modality, and adequacy of molecular testing.
Among 213 patients (64.3% male; mean age 56±14.5 y), the overall diagnostic yield was 92%. Indications for biopsy comprised 134 suspected carcinomas and 79 suspected benign or lymphoproliferative cases. Diagnostic yield was 91.8% (n=123/134) in suspected carcinoma and 92.4% (n=73/79) in suspected benign or lymphoproliferative disease. Molecular testing was processed in 57 malignant cases, with 89.5% successful completion.
A structured, MDT-driven endosonographic strategy was associated with high diagnostic and molecular adequacy in this cohort of malignant and benign mediastinal/hilar lymphadenopathy. Given the nonrandomized design and small sample size, findings should be interpreted cautiously. Prospective studies are warranted to further define the optimal role of each modality.

PMID:
42687840
Bibliographic data and abstract were imported from PubMed on 03 Sep 2026.

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