Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Abstract

Purpose Tissue acquisition in lung cancer is vital for multiple reasons. Primary reasons reported for molecular testing failure in lung cancer biopsy specimens include insufficient amount of tumor cells provided and inadequate tissue quality. Robotic bronchoscopy is a new tool enabling peripheral pulmonary lesion sampling; however, diagnostic yield remains imperfect possibly due to the location of nodules adjacent to or outside of the airway. The 1.1-mm cryoprobe is a novel diagnostic tool and accesses tissue in a 360-degree manner, thus potentially sampling eccentric/adjacent lesions. This study examines the diagnostic yield of the cryoprobe compared to standard needle aspiration and forceps biopsy. It additionally evaluates yield for molecular markers in cases of lung cancer. Methods This is a retrospective analysis of 112 patients with 120 peripheral pulmonary lesions biopsied via robotic bronchoscopy using needle aspirate, forceps, and cryobiopsy. Results The overall diagnostic yield was 90%. Nearly 18% of diagnoses were made exclusively from the cryobiopsy sample. Molecular analysis was adequate on all cryobiopsy samples sent. Digital imaging software confirmed an increase in quantity and quality of samples taken via cryobiopsy compared to needle aspirate and traditional forceps biopsy. Conclusion Using the 1.1-mm cryoprobe to biopsy PPN combined with the Ion robotic bronchoscopy system is safe, feasible, and provides more diagnostic tissue than needle aspirates or traditional forceps biopsies. The combination of cryobiopsy with robotic-assisted bronchoscopy increased diagnostic yield, likely due to its 360-degree tissue acquisition which is beneficial when targeting extraluminal lesions adjacent to the airway.

Efficacy of combined transbronchial lung cryobiopsy and conventional forceps biopsy for lung malignancies: a prospective cohort study

“…In particular, the disposable cryoprobe's flexibility allows the use of a narrow bronchoscope to approach the apex of the lung, which has a strong curvature, and its combined use with conventional biopsy has been reported to increase the diagnostic yield 9,26,27 . In addition, it may be useful to combine the peripheral cryoprobe approach with new technologies such as F-ENB and robotic assist, and this should be investigated as well 28,29 .…”

Robotic Bronchoscopy: Review of Three Systems

“…New biopsy techniques are likely needed, given previous reports of sub-perfect diagnostic yield, despite 100% tool-in-lesion confirmation. Research in steerable needles [ 71 ], RB mounted cryobiopsy probes for peripheral biopsy [ 72 ], and the application of next-generation sequencing to small tissue biopsies [ 73 ] may ultimately help close the diagnostic gap.…”

NSCLC in the Era of Targeted and Immunotherapy: What Every Pulmonologist Must Know

“…A recent analysis of RAB with different sampling methods including needle aspiration, transbronchial forceps, and cryobiopsy were evaluated. Cryobiopsy produced less crush artifact and obtained a median amount of diagnostic tissue, approximately 11-fold higher, than needle aspiration and 2-fold higher than transbronchial forceps [ 67 ]. Forty-nine cases of NSCLC were analyzed via IHC, fluoresence in situ hybridization (FISH), and NGS.…”

“…Forty-nine cases of NSCLC were analyzed via IHC, fluoresence in situ hybridization (FISH), and NGS. One hundred percent (n = 29) of cryobiopsy, 83% (n = 18) of forceps biopsy, and 50% (n = 2) of needle aspiration specimens were acceptable for such extensive analysis [ 67 ]. This study provides important insight into promising new biopsy approaches to improve concurrent diagnosis and molecular analysis.…”