Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD).

Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD).

Is walking barefoot a risk factor for diabetic foot disease in developing countries?

In diagnosing peripheral pulmonary lesions (PPL), radial endobronchial ultrasound (R‐EBUS) is emerging as a safer method in comparison to CT‐guided biopsy. Despite the better safety profile, the yield of R‐EBUS remains lower (73%) than CT‐guided biopsy (90%) due to the smaller size of samples. We adopted a hybrid method by adding cryobiopsy via the R‐EBUS Guide Sheath (GS) to produce larger, non‐crushed samples to improve diagnostic capability and enhance molecular testing. We report six prospective patients who underwent this procedure in our institution. R‐EBUS samples were obtained via conventional sampling methods (needle aspiration, forceps biopsy, and cytology brush), followed by a cryobiopsy. An endobronchial blocker was placed near the planned area of biopsy in advance and inflated post‐biopsy to minimize the risk of bleeding in all patients. A chest X‐ray was performed 1 h post‐procedure. All the PPLs were visualized with R‐EBUS. The mean diameter of cryobiopsy samples was twice the size of forceps biopsy samples. In four patients, cryobiopsy samples were superior in size and the number of malignant cells per high power filed and was the preferred sample selected for mutation analysis and molecular testing. There was no pneumothorax or significant bleeding to report. Cryobiopsy samples were consistently larger and were the preferred samples for molecular testing, with an increase in the diagnostic yield and reduction in the need for repeat procedures, without hindering the marked safety profile of R‐EBUS. Using an endobronchial blocker improves the safety of this procedure.

BackgroundComputed tomography‐guided transthoracic biopsy (CT‐TTB) is the ‘gold standard’ biopsy for lung nodules. Radial‐endobronchial ultrasound (R‐EBUS) bronchoscopy is another recommended biopsy but carries a lower diagnostic yield. Addition of cryobiopsy with R‐EBUS (Cryo‐Radial) has shown promising results. There are no studies comparing CT‐TTB with Cryo‐Radial biopsy.AimThe co‐primary aims were the diagnostic yeild and safety. The secondary aim: ability to test epidermal growth factor receptor (EGFR).MethodsA randomised controlled, multicentre exploratory study was conducted at three tertiary hospitals. Patients with nodules >1 cm on CT of the chest were randomised to CT‐TTB or Cryo‐Radial. With Cryo‐Radial, patients had 1–3 cryo‐biopsies in addition to at least one R‐EBUS biopsy through the 2.6 mm guide sheath.ResultsForty‐eight patients were randomised: 22 to CT‐TTB and 26 to Cryo‐Radial. Sixteen in the CT‐TTB and 20 in the Cryo‐Radial received the allocated biopsy. The diagnostic yield was CT‐TTB 93.8% (15/16) versus Cryo‐Radial 85% (17/20) P = 0.61 and the odds ratio was 0.37. For 5/13 (38%), a diagnosis was solely made on cryobiopsy. Eleven (78%) of 14 in CT‐TTB versus 7/10 (70%) Cryo‐Radial were suitable for EGFR testing P = 0.66, with odds ratio 0.63. Pneumothorax occurrence was 44% (7/16) in CT‐TTB versus 4.2% (1/24) in Cryo‐Radial. Two (12.5%) of 16 CT‐TTB required chest drain insertion.ConclusionCryo‐Radial is comparable in diagnostic yield and ability to perform EGFR testing with a significantly lower risk of pneumothorax, compared with CT‐TTB. Cryo‐Radial has the additional advantage of mediastinal staging during the same procedure with Linear‐EBUS and is a promising first‐line tool in the diagnostic method of lung cancer.