Endobronchial ultrasound‐guided transbronchial cryo‐nodal biopsy: a novel approach for mediastinal lymph node sampling

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is preferred for evaluating malignant lymph nodes and staging of lung cancer. Nevertheless, larger tissue samples are increasingly needed, particularly for molecular analysis. We describe the feasibility, technical details, and complications of EBUS-guided transbronchial cryo-node biopsy (TBCNB) in four patients with mediastinal adenopathy. The samples obtained by EBUS-TBCNB in all cases were adequate for histopathological examination (HPE) and immunohistochemistry (IHC) staining. In case 1, HPE showed non-caseating epithelioid granuloma with giant cells and fibrosis consistent with sarcoidosis. Case 2 was diagnosed with adenocarcinoma with positivity for ROS1(D4D6). Case 3 showed features of metastatic adenocarcinoma from the breast (positive for Her2, ER, and GATA3). Case 4 was diagnosed with tuberculosis (necrotizing granuloma in histopathology, stain with Ziehl-Neelsen that showed few rodshaped bacilli). Only one patient had minimal bleeding at the puncture site controlled with cold saline. There were no adverse events such as major bleeding, pneumomediastinum, or pneumothorax.

Potential application of cryobiopsy for histo-molecular characterization of mediastinal lymph nodes in patients with thoracic malignancies: a case presentation series and implications for future developments

“…At present time, while the required expertise is being developed, one possible approach might be based on the conjunction of cryobiopsy and EBUS TBNA within the same procedure. In first place, adding the cryobiopsy to standard EBUS TBNA does not appear to increase discomfort or risks related to the procedure, at least based on our experience and the recent series published by Gonuguntla et al [ 11 ]. In second place, the simultaneous use of cryobiopsy and EBUS TBNA might result in more informative sample collection, as cryobiopsy allows to obtain actual histologic samples, potentially more informative on tumor architecture and with more material for comprehensive molecular analysis than cytologic samples, while at the same time EBUS TBNA can be easily performed on multiple lymph nodal stations at the same time, allowing to approach stations which might be difficult to access with cryobiopsy.…”

“…Nonetheless, its use in the transbronchial approach to mediastinal lymph nodes in cancer management is still limited, possibly due to the need of specific training for developing adequate skill in both endoscopy and cryobiopsy. To date, another case series, including 4 patients, suggests the feasibility and safety of cryobiopsy for mediastinal lymph nodes, and its consistency with EBUS TBNA [ 11 ].…”

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Technical Updates and Pathological Yield

“…A histological sampling of the lymph node has been reported with the use of a 1.1 mm cryobiopsy probe placed in the same hole created by the TBNA with a 3 sec freeze time before pulling the probe out. The specimen is thawed in saline and fixed in formalin [ 32 ]. In a prospective study of 197 patients undergoing EBUS-TBNA and EBUS cryobiopsy for mediastinal lesions of at least 1 cm, cryobiopsy had higher sensitivity than TBNA in rare tumors (91% vs. 25%; p = 0.001) and benign disorders (81% vs. 53%; p = 0.04).…”

Mediastinal “deep freeze”—transcarinal lymph node cryobiopsy

“…A small number of case reports described a novel method of transcarinal cryobiopsy from mediastinal lymph nodes, 7,8 and recently a randomized clinical trial was published with impressive diagnostic results. 9 In this prospective pilot trial, we assessed the efficacy and safety of transcarinal EBUS-guided lymph node cryobiopsy, following EBUS-TBNA in 24 patients.…”