Mediastinal “deep freeze”—transcarinal lymph node cryobiopsy

Abstract

Background: The diagnostic yield of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) from mediastinal lymph nodes ranges from 66%-89%. However, in many cases cytologic material is not sufficient for full molecular evaluation. A novel method of transcarinal cryobiopsy aims to provide bronchoscopically obtained, larger specimen samples from mediastinal lymph nodes. We aimed to assess the efficacy and safety of transcarinal EBUS-guided lymph node cryobiopsy. Methods: Patients referred for EBUS-TBNA, based on abnormal mediastinal clinical and radiographic findings, were enrolled into this prospective interventional study between July 2020 and August 2021. All EBUS-TBNA procedures were performed using ProCore 22G needle (Cook Medical) to create, both a transcarinal tract for the cryoprobe and to obtain TBNA samples. For EBUS guided transcarinal cryobiopsy, we used flexible 1.1 mm or 1.7 mm cryoprobe inserted into the working channel of the EBUS scope and into the target subcarinal lymph node. Results: Twenty-four patients with male predominance 2:1 and mean age of 60.12 AE 10.16 years were enrolled. All target lymph nodes had hypoechoic, homogenic consistency with demarcated borders, without central structures. Cryobiopsy provided pathological diagnosis in 20 cases (83.33%), with 1.1 mm cryoprobe in 14 and with 1.7 mm cryoprobe in 6 cases. In one case each, pathology was provided by TBNA or by cryoprobe alone. No immediate or late complications were encountered during the procedures. Conclusion: Transcarinal EBUS guided lymph node cryobiopsy following EBUS-TBNA proved to be efficient with a high diagnostic yield and can be considered safe, because no immediate or late complications occurred.

Esophageal submucosal tumor diagnosed with EBUS‐guided transbronchial mediastinal cryobiopsy: A case report

“…However, needle‐based specimens such as EBUS‐TBNA and EUS‐FNA are considered inadequate for immunostaining in many cases due to tissue volume, blood contamination, and crushing 5,6,12–14 . The addition of EBUS‐IFB or EBUS‐cryo to EBUS‐TBNA has been reported to have diagnostic utility, especially for lymphomas, uncommon tumors, and benign diseases 5–9 . A prospective study reported that only 46% of EUS‐FNA specimens for SMT were immunostainable, 13 and the diagnostic yield for SMTs was insufficient, ranging from 46% to 84%, 12–14 therefore biopsy methods for SMTs with high diagnostic rates need to be established.…”

“…Although its sensitivity and specificity are high for staging non‐small‐cell lung cancer, diagnostic yields for non‐cancer diseases are insufficient 1–6 . Recent studies have shown that adding EBUS‐guided intranodal forceps biopsy (EBUS‐IFB) or EBUS‐guided transbronchial mediastinal cryobiopsy (EBUS‐cryo) to EBUS‐TBNA provides higher diagnostic yields for lymphoma, uncommon tumors, and benign diseases compared to EBUS‐TBNA alone 5–9 …”

Airway stenosis complicated by endobronchial ultrasound‐guided tissue acquisition: A case report

“…Here, clarifying the main reason for AS after EBUS‐TA was difficult; the involvement of the size of the tract created by EBUS‐TBNA and EBUS‐IFB cannot be ruled out. However, AS due to TS has not been reported, even in EBUS‐cryo, 9 , 10 which can help pass larger specimens through the tract than EBUS‐IFB. Therefore, we speculate that characteristics of CAC, which was poorly responsive to chemotherapy, were probably involved.…”

“…Endobronchial ultrasound (EBUS)‐guided tissue acquisition (TA) performed by transbronchial needle aspiration (TBNA) is the main diagnostic procedure for mediastinal and hilar lymphadenopathies given its safety and minimal invasiveness 1–6 . While EBUS‐TBNA has high sensitivity and specificity for diagnosing lymph node (LN) metastasis in lung cancer, 1,2 additional TA with EBUS‐TBNA, such as EBUS‐guided intranodal forceps biopsy (EBUS‐IFB) or EBUS‐guided cryobiopsy (EBUS‐cryo), can achieve higher diagnostic yields of lymphomas, uncommon tumors, and benign diseases, such as sarcoidosis 7–10 . EBUS‐IFB and EBUS‐cryo are advantageous as they can help obtain histological tissue samples 8,9 .…”

“… 1 , 2 , 3 , 4 , 5 , 6 While EBUS‐TBNA has high sensitivity and specificity for diagnosing lymph node (LN) metastasis in lung cancer, 1 , 2 additional TA with EBUS‐TBNA, such as EBUS‐guided intranodal forceps biopsy (EBUS‐IFB) or EBUS‐guided cryobiopsy (EBUS‐cryo), can achieve higher diagnostic yields of lymphomas, uncommon tumors, and benign diseases, such as sarcoidosis. 7 , 8 , 9 , 10 EBUS‐IFB and EBUS‐cryo are advantageous as they can help obtain histological tissue samples. 8 , 9 However, they require the creation of a tract for inserting forceps or cryoprobes through the tracheal/bronchial wall and LN capsule, which may result in unforeseen complications.…”