Combination of 1.1 mm flexible cryoprobe with conventional guide sheath and therapeutic bronchoscope in biopsy of apical upper lobe solitary pulmonary nodule

Abstract

Background: Lung cancer is frequently situated peripherally in the upper lobes of the lung. Acquiring adequate tissue from this difficult-to-reach area remains a challenge. Transbronchial cryobiopsy (TBCB) has the ability to acquire larger specimens, but the rigidity of the standard 1.9 mm and 2.4 mm cryoprobes frequently poses challenges when used with a guide sheath (GS). The novel 1.1 mm cryoprobe, being both smaller and more flexible, may address this limitation. We describe the usage of this 1.1 mm flexible cryoprobe with GS in the biopsy of solitary pulmonary nodules (SPN) in the apical segment of the upper lobe in two cases. Case report: Both procedures were conducted with advanced airway under total intravenous anaesthesia. 2.6 mm GS was used in combination with a 2.2 mm rEBUS probe, using a therapeutic bronchoscope. Case 1 describes a SPN in the apical segment of the right upper lobe that was inconclusive by forceps biopsy due to GS displacement and inadequate biopsy depth. A steerable GS combined with the novel cryoprobe subsequently overcame this issue. Case 2 describes a SPN in the apical segment of the left upper lobe in which the standard cryoprobe failed to advance through the GS due to steep angulation. It also highlights with shorter activation time, the novel cryoprobe enable biopsied tissue to be retrieved through the GS while the bronchoscope-GS remains wedgend in the airway segment. There were no bleeding or pneumothorax complications in both cases, and histopathological examination confirmed adenocarcinoma of the lung. Conclusion: The 1.1 mm flexible cryoprobe in combination with GS and therapeutic bronchoscope offers an option to acquire adequate tissue in difficult-to-reach regions in the lung such as the apical segment of upper lobes. Further prospective series to evaluate its performance and safety in SPN biopsy is highly anticipated.

Hemorrhage Risk of Patients Receiving Bronchoscope Examination or Treatment

“…A few studies reported the complications and the incidence in bronchoscopy [2,[9][10][11][12] . According to a study of 20,986 bronchoscopies [4] , the most common complications were hemorrhage, oxyhemoglobin desaturation, pneumothorax, and pulmonary edema.…”

Diagnostic value of ultrathin bronchoscopy in peripheral pulmonary lesions: a narrative review

“…An ultrathin 1.1-mm cryoprobe, which is used through the working channel of an ultrathin bronchoscope, has already been adopted in clinics worldwide. The ultrathin cryoprobe is flexible enough to access PPLs located past the deepcurved bronchus (51) of a small sample size. Bronchoscope manufacturers have continued efforts to develop thinner bronchoscopes with larger working channels and better visibility.…”

Comparison of the analytical performance of the Oncomine dx target test focusing on bronchoscopic biopsy forceps size in non‐small cell lung cancer

“…15,16 In recent years, a novel 1.1 mm cryoprobe, which can pass through the 1.7 mm working channel of a BF-MP 290F, became available in clinical settings, and therefore it is expected that large specimens can even be collected with an ultrathin bronchoscope. 17 It is also important to consider trying another sampling method, such as EBUS-TBNA, CTNB and surgical biopsy, if the specimen obtained from EBB/TBB is not appropriate for NGS analysis. 7,8,10 There were several limitations to this study.…”