Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions

Abstract

BackgroundRadial endobronchial ultrasound (R-EBUS) is an effective technique in the diagnosis of peripheral pulmonary lesions (PPL). However, lesion orientation with regards to the radial probe remains an important factor for effective biopsy. “Within” orientation was associated with significantly higher diagnostic yield. Cryobiopsy is a novel technique in obtaining larger tissue samples with the frozen tip allowing biopsy in a 360° direction, thus potentially achieving more effective biopsy in eccentrically and adjacently orientated lesions. We aimed to evaluate the performance and safety of transbronchial cryobiopsy versus forceps biopsy in eccentrically and adjacently orientated R-EBUS lesions.MethodsRetrospective review of R-EBUS transbronchial biopsy for PPL over 17 months.Results114 R-EBUS scans were included for analysis during the study period. Forceps biopsy was performed in 76 (66.7%) cases and cryobiopsy in 38 (33.3%) cases. Baseline demographics and lesion characteristics did not differ between the two groups. Median (interquartile range) lesion size was 3.48 (2.63–4.51) cm. Overall, 41.2% of lesions were of eccentric orientation and 15.8% adjacent orientation; only 43% were concentric in orientation. Overall diagnostic yield was 67.5% (77 out of 114). Orientation remained an important factor affecting diagnostic yield. Transbronchial cryobiopsy significantly increased the diagnostic yield in eccentrically and adjacently orientated lesions to 75.0% (18 out of 24), compared to 48.8% (20 out of 41) obtained via forceps biopsy (p<0.05); but not in concentric lesions. Cryobiopsy was associated with more mild and moderate bleeding complications compared to the forceps biopsy group.ConclusionsTransbronchial cryobiopsy under R-EBUS guidance is a safe procedure which potentially increases diagnostic yield in eccentrically and adjacently orientated PPLs.

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

“…Transbronchial cryobiopsy (TBCB) is widely used in the diagnosis of diffuse parenchymal lung disease (DPLD), the use of which has been standardized through expert recommendations [7]. However, its role in SPN diagnosis remains uncertain although various studies have demonstrated its feasibility, especially if lesions are eccentric or adjacently orientated to rEBUS [4,8]. However, the conventional cryoprobe is stiff and may not be easily inserted into all regions of the lung, especially in highly angulated bronchi such as the apical segment of the upper and lower lobe [5].…”

Cryobiopsy In Flexi-Rigid Pleuroscopy in a Region with Low Mesothelioma Prevalence

“…4,10 As opposed to conventional forceps, which only allow forward sampling, cryoprobe can obtain tissue in a 360 o manner laterally. 24 Similarly, in the experience with Case 4, nodules that were tangentially oriented despite having the pleuroscope at maximal angulation were much easier to sample with cryoprobe than conventional forceps. Third, in terms of technical difficulty, there is no significant difference in operator-rated difficulty when comparing cryobiopsy to conventional forceps technique; 12 this is promising and may encourage more pulmonologists to adopt it in the future, although studies on its learning curve are lacking.…”

A Pilot Study of the Ultrathin Cryoprobe in the Diagnosis of Peripheral Pulmonary Ground-Glass Opacity Lesions

“…Conventional cryoprobe was thick and straight and limited to large bronchus. Hemorrhage is also a considerable problem and it induced more bleeding than forceps [15,[25][26][27]. Usually, the conventional cryoprobe need to be withdrawn with bronchoscope after biopsy, leaving the airway out of surveillance, so an additional insertion of a bronchoscope is required immediately after the former bronchoscope retreated [28].…”