Participants undergoing EBUS-TBMC for suspected mediastinal lymph node tuberculosis. The procedure is performed under moderate sedation or general anesthesia. After locating the target lymph node via EBUS, a tunnel is created using a puncture dilation catheter. The outer sheath is left in place to maintain the tunnel. A cryoprobe is then inserted through the sheath into the lymph node, ensuring the tip is at least 5 mm from the node edge and visible vessels. Freezing is activated using carbon dioxide to obtain tissue samples. A total of three independent cryobiopsy specimens are collected from the same target node. A portion of each specimen is sent for mycobacterial culture and Xpert MTB/RIF testing; the remaining tissue is fixed in formalin for histopathological evaluation. In this paired design study, all participants undergo both EBUS-TBMC and EBUS-TBNA procedures on the same lymph node during a single session, with the sequence determined by randomization.

Participants undergoing standard EBUS-TBNA for suspected mediastinal lymph node tuberculosis. The procedure is performed under moderate sedation or general anesthesia. Using a 22G EBUS aspiration needle, the target lymph node is punctured under real-time ultrasound guidance. Standard "to-and-fro" movements are performed approximately 30 times per pass. A total of five independent needle passes are performed on the same target node. The first pass specimen is collected directly into sterile saline for mycobacterial culture. The remaining specimens are rinsed into formalin for cell block preparation. The rinsing fluid from the needle and specimen container is also collected for Xpert MTB/RIF testing and culture. In this paired design study, all participants undergo both EBUS-TBNA and EBUS-TBMC procedures on the same lymph node during a single session, with the sequence determined by randomization.

EBUS-TBMC is a minimally invasive bronchoscopic procedure performed under moderate sedation or general anesthesia to obtain larger and more intact tissue samples from mediastinal lymph nodes compared to conventional needle aspiration. A convex probe EBUS scope is used to identify the target lymph node, and Doppler mode is employed to map vascular structures for safe puncture path planning. A dedicated puncture dilation catheter is inserted under real-time EBUS guidance to puncture the airway wall and enter the target lymph node; the needle stylet is then removed, leaving the outer sheath in place to establish a "tunnel" from the airway lumen into the lymph node parenchyma. A flexible cryoprobe is advanced through the sheath into the lymph node, with ultrasound confirmation ensuring the probe tip is positioned within the node while maintaining a safety distance of at least 5 mm from the nodal edge and any visible blood vessels. The freezing system is activated using carbon dioxide as th

The proportion of patients in whom granulomatous inflammation is detected on histopathological examination of the biopsy specimens obtained from the target mediastinal lymph node. Assessment will be performed by pathologists blinded to the biopsy technique used for each specimen.

The proportion of patients with a positive culture for Mycobacterium tuberculosis from the biopsy specimens obtained from the target mediastinal lymph node.