The Safety of Cryobiopsy in Diagnosing Carcinoid Tumors

Boyd, Michael; Sahebazamani, Mitra; Ie, Susanti; Rubio, Edmundo

doi:10.1097/lbr.0000000000000079

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Although the safety of flexible bronchoscopic biopsy is controversial, some investigators have reported cases of serious bleeding. Recently, the usefulness of cryobiopsy for diagnosing carcinoid, which provides larger and higher quality specimens than conventional forceps biopsy, has been reported (Boyd et al 2014;Gao et al 2020). However, it is likely associated with a higher frequency of bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

The Role of Rigid Bronchoscopic Intervention for Bronchial Carcinoid

Torii

Oki

Ishii

et al. 2021

Tohoku J. Exp. Med.

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Bronchial carcinoid is a rare malignant tumor that is categorized as a typical carcinoid or atypical carcinoid. Many institutions use flexible bronchoscopy for diagnosis. However, due to the hemorrhagic nature of the tumor, the amount of specimen obtained is often small, making it difficult to obtain an accurate diagnosis. The use of rigid bronchoscopy may not only contribute to obtaining a diagnosis but also be beneficial in the treatment plan. The aim of this study was to evaluate the efficacy of rigid bronchoscopic interventions for the diagnosis and treatment of bronchial carcinoids. All patients with bronchial carcinoids who underwent rigid bronchoscopic intervention under general anesthesia at our institution between June 2006 and August 2018 were analyzed retrospectively. Eight patients [3 men and 5 women; median age, 71 years (range 45-82 years)] were eligible for the analysis. None of the cases had accurate subtyping preoperatively before intervention. In contrast, all cases were diagnosed as carcinoid with subtypes (5 patients had typical carcinoid and 3 had atypical carcinoid) following rigid bronchoscopic intervention. All respiratory symptoms improved immediately after the procedure. One instance of bleeding occurred, and was easily controlled by argon plasma coagulation and intraluminal administration of epinephrine under flexible and rigid bronchoscopy. Four patients (3 with typical carcinoid and 1 with atypical carcinoid) underwent radical surgery sequentially, and no recurrences were observed. We conclude that rigid bronchoscopic intervention is safe and effective for accurate diagnosis and improvement of respiratory symptoms in patients with bronchial carcinoids.

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Section: Discussionmentioning

confidence: 99%

The Role of Rigid Bronchoscopic Intervention for Bronchial Carcinoid

Torii

Oki

Ishii

et al. 2021

Tohoku J. Exp. Med.

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“…During the initial procedure, tumor biopsy was taken for histologic confirmation, either by means of cryoextraction (achieved by rapid withdrawal of the cryoprobe after freezing part of the lesion for ∼3 s or until evidence of visible freezing) or with the use of biopsy forceps, depending on individual operator’s clinical judgment and/or preference. In general, we advocate the use of cryoprobe extraction over biopsy forceps, because it reduces the risk of yielding small specimen samples with severe crush artefacts in which mitotic count may be difficult to evaluate 16–18. Intraoperative bleeding occurring at the tumor site was controlled with boluses of 10 ml of adrenaline 1:100,000 solution and/or use of the cryoprobe at the bleeding point.…”

Section: Methodsmentioning

confidence: 99%

“…In general, we advocate the use of cryoprobe extraction over biopsy forceps, because it reduces the risk of yielding small specimen samples with severe crush artefacts in which mitotic count may be difficult to evaluate. [16][17][18] Intraoperative bleeding occurring at the tumor site was controlled with boluses of 10 ml of adrenaline 1:100,000 solution and/or use of the cryoprobe at the bleeding point.…”

Section: Cryotherapy Proceduresmentioning

confidence: 99%

Treatment of Pulmonary Carcinoid Tumors With Bronchoscopic Cryotherapy

Perikleous

Mayer

Finch

et al. 2021

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Pulmonary carcinoids are rare tumors originating from neuroendocrine cells in the lungs. Because of their potentially infiltrative nature, surgical resection remains the treatment of choice. However, not all patients with technically resectable disease will be able to undergo surgery, primarily because of poor lung function or medical co-morbidities. Centrally located, intraluminal tumors have been reported to be amenable to bronchoscopic treatment. We specifically examined the role of cryotherapy in the treatment of bronchial carcinoid tumors. Methods: Sixty-three patients (52.38% female) who underwent a combined total of 243 cryotherapy procedures for treatment of bronchial carcinoid between 1992 and 2020 in our institution were included in the study. Following discussion in multidisciplinary meetings, patients were considered for first-line cryotherapy when lung resection was deemed not possible or when they had rejected surgery.Results: Cryotherapy resulted in complete remission in 21 (33.33%) patients with maximum tumor diameter less than 20 mm (mean: 11.08 mm, 95% confidence interval: 8.76-13.40), and allowed 22 (34.92%) patients with larger lesions (mean: 24.04 mm, 95% confidence interval: 18.78-29.30) to proceed with parenchymal sparing resections. Marked symptomatic relief (P < 0.001) was reported by 58 (92.06%) patients. The median follow-up was 33 months (range: 0 to 243 mo). One (1.59%) patient was diagnosed with recurrence in a contralateral lobe 3 years after surgery and was treated with radiofrequency ablation.Conclusions: In the absence of a definitive randomized controlled trial comparing bronchoscopic treatment with surgical resection, we provide evidence on the safety and efficacy of cryotherapy and encourage wider adoption of this inexpensive and minimally invasive technique for treatment of bronchial carcinoids.

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“…98 Several studies have confirmed these findings, 103 including the safety in the diagnosis of carcinoid tumours. 104 Peripheral lung lesions Schumann et al evaluated the accuracy in the diagnosis of peripheral lesions with the guidance of rEBUS: the diagnostic yield of 74.2% was not significantly higher in comparison with that of EBUS-guided forceps biopsy (61.3%); however, samples were significantly larger than those collected by TBB. 105 Other studies showed a diagnostic yield of 69---85% when guided by ultrasounds or EMN, and confirmed the advantage of larger samples and a better preserved architecture, thus improving the specimen quality for the molecular diagnosis.…”

Section: Endobronchial Lesionsmentioning

confidence: 99%