Cryobiopsy in the diagnosis of peripheral lung lesion

Abstract

Introduction: transbronchial cryobiopsy (TBCB) guided by fluoroscopy and radial mini probe endobronchial ultrasound (RP-EBUS) is a novel technique in the diagnosis of peripheral lung lesion (PLL). Aim: to evaluate and compare the diagnostic values, safety of TBCB, transbronchial forceps biopsy (TBFB) and combined procedures (TBFB+TBCB) in the diagnosis of PLL. Methods: the clinical study was executed at Hospital of Lithuanian University of Health Sciences (LUHS) Kauno Klinikos, Department of Pulmonology from September 2019 to December 2021. 50 patients with peripheral lung lesion on the chest computed tomography were enrolled. TBFB and TBCB were performed for all patients with detectable PLL by fluoroscopy and RP-EBUS. All patients underwent to general anesthesia and intubation with the rigid bronchoscope (KARL STORZ) and high frequency jet ventilation (TwinStream). For TBCB we used 1.1, 1.7 and 1.9 mm cryoprobes (CRYO2 system, ERBE2) with freezing time of 4-12 seconds and 5 -7 Fr (Olympus) endobronchial blocker to stop bleeding were used as well. Results: Age, mean±SD,69.30±8.50 years. Gender: male 68.0% and female 32.0%. PLL size, mean±SD,3.50±2.05cm. RP-EBUS probe position: 20 cases(40.0%) within and 30 cases(60.0%) adjacent to the PLL. Overall diagnostic yield of TBFB was 72.0%(36/50), TBCB 84.0%(42/50), combined procedures 90.0%(45/90), respectively (p<0.05). TBFB diagnostic yield when RP-EBUS was within PLL 85.0%(17/20) and adjacent to PLL 63.3%(19/30), TBCB – 90.0%(18/20) and 80.0%(24/30), combined procedures 95.0%(19/20) and 86.6%(26/30), respectively. No severe bleeding, pneumothorax or death was registered. Conclusion: TBCB is a safe procedure, which increase the diagnostic yield of PLL, irrespective of RP-EBUS position.