Sergio Alcolea Batres

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–computed tomography (PET–CT) 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-56–74], 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 90.7–100) than for EBUS-TBNA (88.9%, 95% CI 79.6–98.2). 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—or alternative—to conventional EBUS-TBNA in the assessment of mediastinal lymph nodes.

Background: Flexible bronchoscopy (FB) is a widely used diagnostic and therapeutic procedure in patients with pulmonary disease, many of whom are at risk of gas exchange impairment. FB may exacerbate hypoxaemia due to increased airway resistance, alveolar derecruitment, and haemodynamic fluctuations. Objectives: To assess the effectiveness of non-invasive respiratory support strategies in preventing oxygen desaturation and respiratory complications during FB. Methods: A systematic review and meta-analysis were conducted using PubMed and Cochrane databases, covering studies from 2000 to 2024. Inclusion criteria focused on adult patients undergoing FB with any form of non-invasive oxygen support. Twelve high-quality studies were selected, including randomised trials and prospective cohorts. Results: High-flow therapy (HFT) was more effective than conventional oxygen therapy (COT) in maintaining oxygenation and reducing procedure interruptions, especially in patients with moderate hypoxaemia or risk factors such as obesity and obstructive sleep apnoea. Continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) offered superior oxygenation and ventilatory support in patients with more severe respiratory or cardiac compromise. Conclusions: Non-invasive respiratory support should be individualised based on patient risk and procedural complexity. HFT benefits mild-to-moderate cases, while CPAP or NIV is preferable in more severe conditions. Further multicentre randomised trials are needed to establish formal guidelines.

Changes in nutritional status, such as weight loss and malnutrition, are a very common complication in patients with chronic obstructive pulmonary disease (COPD). These changes primarily affect the patients' quality of life and functional capacity and they are also independent prognostic indicators of both morbidity and mortality. Malnutrition in these patients is due to multiple factors including increases in resting energy expenditure, decreased food intake, the effects of certain drugs, and, perhaps most importantly, a high systemic inflammatory response. The present review covers the most important facets of the prevalence, etiology, pathogenesis, and consequences of malnutrition in COPD and considers which parameters for nutritional assessment are the most satisfactory for use in routine clinical practice. The strategy used to ensure correct nutritional status in these patients is also discussed.