Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated Systematic Review and Meta-Analysis

Abstract

BackgroundCryobiopsy has emerged as a novel alternative to conventional forceps biopsy for the diagnosis of interstitial lung diseases (ILDs), lung tumors, and peripheral pulmonary lesions (PPLs). This study aims to compare cryobiopsy and forceps biopsy for the diagnosis of these lung pathologies with respect to efficacy and safety by performing a meta-analysis of updated evidence.MethodsA number of databases, such as PubMed, Embase, Web of Science, the Cochrane Library, OVID, CNKI, and Wanfang database, were searched for eligible studies. Randomized and non-randomized comparative studies investigating the efficacy and safety of cryobiopsy vs. forceps biopsy for lung pathologies were included. Pooled results were calculated as an odds ratio (OR) or standardized mean difference (SMD) with 95% CI.ResultsA total of 39 studies, such as 9 RCTs with 3,586 biopsies (1,759 cryobiopsies and 1,827 flexible forceps biopsies) were analyzed. Cryobiopsy was associated with a significant increase in the diagnostic rates of ILDs (OR, 4.29; 95% CI, 1.85–9.93; p < 0.01), lung tumors (OR, 3.58; 95% CI, 2.60–4.93; p < 0.01), and PPLs (OR, 1.70; 95% CI, 1.23–2.34; p < 0.01). Cryobiopsy yielded significantly larger specimens compared with flexible forceps biopsy (SMD, 3.06; 95% CI, 2.37–3.74; p < 0.01). The cryobiopsy group had a significantly higher (moderate to severe) bleeding risk than the forceps group (OR, 2.17; 95% CI, 1.48–3.19; p < 0.01). No significant difference was observed in the incidence of pneumothorax between the groups (OR, 0.90; 95% CI, 0.44–1.85; p = 0.78).ConclusionOur results demonstrate that cryobiopsy is a safe and efficacious alternative to conventional forceps biopsy.

Performance of Biopsy Tools in Procurement of Lung Tissue in Robot-Assisted Peripheral Navigation: A Comparison

“…There were two instances of minor bleeding, both rated 2 or lower on the Nashville Bleeding Scale. Our findings are in line with previous meta-analysis comparing the safety profiles of cryoprobe and forceps, suggesting that the use of a cryoprobe does not increase the risk of bleeding during PPL biopsies [14].…”

“…Previous studies have suggested that cryobiopsy provides larger tissue samples, fewer artifacts, and higher diagnostic yield when compared to traditional transbronchial forceps in diffuse lung diseases [12, 17]. In individuals with PPLs, a recently updated systematic review and meta-analysis revealed that cryoprobes provided higher diagnostic yield over forceps in 9 out of the 13 studies [14]. Griff et al [7] conducted a morphometrical analysis comparing cryoprobe and forceps in transbronchial biopsies.…”

“…Previous research using newer-generation cryoprobes has largely focused on endoluminal lesions or interstitial lung disease, and optimistic results were likely attributed to enhanced probe traction and stability, culminating in larger sample size and improved quality [11, 12]. Recently, several studies have centered on the diagnostic yield of forceps and cryobiopsy for PPLs, revealing an overall diagnostic yield around 80%, suggesting that cryoprobe provides improved diagnostic yield, sample size, and bleeding risks [13, 14]. There has not, however, been a direct comparison between cryoprobe and forceps in terms of their histopathological biopsy performance in diagnosing PPLs using robotic bronchoscopy with CBCT as a secondary confirmation tool.…”

Transbronchial Cryobiopsy Is Superior to Forceps Biopsy for Diagnosing both Fibrotic and Non-Fibrotic Interstitial Lung Diseases

“…Pneumothorax occurred in 10% of our cohort, similar to previously published rates in systemic reviews and meta-analyses [4,8,[15][16][17]. TBCB was not a risk factor for pneumothorax or chest tube placement, as was shown in previous studies [23,29,30]. Our cohort's 6% bleeding rate is lower than most other large-scale studies [9,16,24,31,32].…”

Invasive Mucinous Adenocarcinoma Diagnosed Using Transbronchial Cryobiopsy

“…Transbronchial cryobiopsy (TBCB) is useful a biopsy technique in diagnosing interstitial lung disease (ILD) and lung tumors, as it can collect a sufficient number of specimens without crush damage 4,5) . Although TBCB has a higher risk of bleeding than forceps biopsy 6) , adequate hemostasis can be achieved endoscopically. In ILD diagnosis, it was reported that TBCB specimens combined with various clinical findings might avoid invasive surgical lung biopsy 7,8) .…”