Abstract: Objective To evaluate the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) for pulmonary sarcoidosis, and to explore the clinical value of EBUS-TMC in the diagnosis of pulmonary sarcoidosis. Methods A total of 63 patients with suspected stage Ⅰ or stage Ⅱ pulmonary sarcoidosis who were admitted to Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Xuzhou Medical University between December 2023 and March 2025 were selected and their clinical data were retrospectively analyzed. According to the diagnostic procedures, the patients were divided into an EBUS-TBNA group (n=42) and an EBUS-TMC group (n=21). The diagnostic efficacy of EBUS-TBNA and EBUS-TMC for pulmonary sarcoidosis was evaluated, with clinical diagnosis and follow-up results as the gold standard.Results In the EBUS-TBNA group, the sensitivity was 74.3%, the specificity was 85.7%, and the area under the receiver operating characteristic (ROC) curve (AUC) was 0.800. In the EBUS-TMC group, the sensitivity was 87.5%, specificity was 100%, and the AUC was 0.938. The AUC was significantly higher in the EBUS-TMC group than in the EBUS-TBNA group (P<0.05).Conclusions EBUS-TMC demonstrates high sensitivity and favorable diagnostic performance for pulmonary sarcoidosis, and shows certain advantages in clinical application compared with EBUS-TBNA. It is a safe and feasible diagnostic modality and worthy of further promotion and wider adoption in clinical practice.