scholarly journals The Safety and Feasibility of Radial Endobronchial Ultrasound-guided Transbronchial Cryobiopsy in Diffuse Pulmonary Infiltrate Diseases

2019 ◽  
Author(s):  
wen chien Cheng ◽  
Meng-Fang Shen ◽  
Biing-Ru Wu ◽  
Wei-Chih Liao ◽  
Chih-Yu Chen ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Medical Center ◽  
Pulmonary Nodules ◽  
Pulmonary Infiltrate ◽  
Sample Volume ◽  
Endobronchial Ultrasound ◽  
Severe Bleeding ◽  
Forceps Biopsy ◽  
Diffuse Parenchymal Lung Diseases ◽  
Transbronchial Lung Cryobiopsy

Abstract Background Transbronchial lung cryobiopsy (TBLC) has emerged as a new bronchoscopic procedure which can improve specimen size and obtain crush artifact-free tissue to increase diagnostic yield in various diffuse parenchymal lung diseases (DPLDs). However, TBLC has been associated with a higher incidence of complications, and variability in diagnostic yield. Radial probe endobronchial ultrasound (R-EBUS) may be able to overcome these problems. We evaluated the safety and feasibility of TBLC in combination with R-EBUS to diagnose DPLDs.Methods We conducted this retrospective study at a single medical center from January 2015 to March 2019. Patients with DPLDs who underwent R-EBUS to locate target lesions and confirm the absence of adjacent vessels, followed by sampling with conventional transbronchial lung forceps biopsy (TBLB) and cryobiopsy (TBLC) were enrolled. TBLC and TBLB samples were sent to the pathology department for diagnostic analysis. The sample size, diagnostic yield and complications after the procedure were recorded.Results A total 30 patients with DPLD were analyzed, of whom 17 had diffuse lung infiltrates and 13 had pulmonary nodules/masses. The overall diagnostic rate was 80% (24/30) and the diagnostic yield increased from 46.7% with the forceps biopsy to 73.3% after adding cryobiopsy (p=0.038). Compared to conventional transbronchial biopsy with forceps, cryobiopsy provided a larger specimen and sample volume (40 mm3 vs 6 mm3; p<0.001). Twenty-two (73.3%) patients had mild bleeding, two (6.7%) had moderate to severe bleeding, and one (3%) had pneumothorax. Ten patients who initially had non-diagnostic results by TBLB received a definite diagnosis after adding TBLC. Among these patients, eight (8/10) were ultimately diagnosed with interstitial lung disease (ILD) (p<0.001).Conclusions TBLC with R-EBUS guidance increased the diagnostic yield in patients with DPLD, particularly in those with ILD. The samples obtained by TBLC were significantly larger and there were no severe complications after the procedure. Larger studies are needed to confirm the safety and feasibility of R-EBUS-guided TBLC.

Mediastinal Nodular Lymphocyte Predominant Hodgkin Lymphoma Achieved by Endoscopic Transesophageal Cryobiopsy

Respiration ◽  
2021 ◽  
pp. 1-5
Author(s):  
Zan-Sheng Huang ◽  
Dong Zhou ◽  
Jing Zhang ◽  
Wan-Lei Fu ◽  
Jing Wang ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Diagnostic Yield ◽  
Cancer Staging ◽  
Needle Aspiration ◽  
Sample Volume ◽  
Small Sample ◽  
Endobronchial Ultrasound ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Initial Sampling

Guidelines have recommended endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine-needle aspiration biopsy as initial sampling approaches of mediastinal lymph nodes for lung cancer staging. However, the small sample volume might restrict the diagnostic utility of needle aspiration in certain mediastinal diseases. We have recently shown that transbronchial mediastinal cryobiopsy, which is capable of providing larger amounts of intact tissue, improves diagnostic yield in rare tumors and benign diseases compared to EBUS-TBNA. Here, we present a case of mediastinal nodular lymphocyte predominant Hodgkin lymphoma successfully diagnosed by endoscopic transesophageal cryobiopsy.

scholarly journals Cryobiopsy in Lung Cancer Diagnosis—A Literature Review

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 393
Author(s):  
Mărioara Simon ◽  
Ioan Simon ◽  
Paul Andrei Tent ◽  
Doina Adina Todea ◽  
Antonia Haranguș
Keyword(s):  
Lung Cancer ◽  
Cancer Diagnosis ◽  
Diagnostic Yield ◽  
Lung Tumors ◽  
Small Sample ◽  
Diagnostic Methods ◽  
Endobronchial Ultrasound ◽  
Forceps Biopsy ◽  
Lung Cancer Diagnosis ◽  
Diagnosis Of Lung Cancer

Optimizing the diagnosis of lung cancer represents a challenge, as well as a necessity, for improving the low survival of these patients. Flexible bronchoscopy with forceps biopsy is one of the key diagnostic procedures used for lung tumors. The small sample size and crush artifacts are several factors that can often limit access to a complete diagnosis, therefore leading to the need of repeating the bronchoscopy procedure or other invasive diagnostic methods. The bronchoscopic cryobiopsy is a recent technique that proved its utility in the diagnosis of both endobronchial and peripheral lung tumors. In comparison with conventional forceps biopsy, studies report a higher diagnostic yield and a superior quality of the collected samples for both the histopathological and the molecular diagnosis of lung cancer. This method shows promising results in sampling lung tissue, alone, or in conjunction with fluoroscopy or radial endobronchial ultrasound (r-EBUS). With a good safety and cost-benefit profile, this novel method has the potential to improve the diagnosis, and therefore the management of lung cancer patients. The objective of this narrative review is to provide a comprehensive review of the recent data regarding the advantages of cryobiopsy and r-EBUS in lung cancer diagnosis.

scholarly journals Evaluation of Pulmonary Nodules Using the Spyglass Direct Visualization System Combined With Radial Endobronchial Ultrasound: A Clinical Feasibility Study

2016 ◽  
Vol 10 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Krystelle Godbout ◽  
Simon Martel ◽  
Mathieu Simon ◽  
Noël Lampron ◽  
Antoine Delage
Keyword(s):  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
Final Diagnosis ◽  
Endobronchial Ultrasound ◽  
Tissue Sampling ◽  
Direct Visualization ◽  
Bronchial Mucosa ◽  
Procedure Time ◽  
Visualization System ◽  
Spyglass Direct Visualization System

Background: Sampling of peripheral pulmonary nodules with radial endobronchial ultrasound (p-EBUS) increases diagnostic yield of bronchoscopy. However, diagnostic yield is influenced by numerous factors. Objective: We evaluated the use of SpyGlass, a one millimeter diameter optic fiber, to obtain images of the distal mucosa and of pulmonary lesions detected with p-EBUS to determine if visual aspect of the distal mucosa was predictive of diagnosis. Methods: We prospectively recruited subjects investigated for peripheral nodules. Bronchoscopy was performed and p-EBUS was used to locate the lesion through a guide sheath. The Spyglass fiber was introduced in the sheath to obtain images of the distal bronchial mucosa. Tissue sampling was subsequently done. Results: Fifteen patients were enrolled in the study. A final diagnosis of malignancy was confirmed in 80%. All lesions could be located using p-EBUS (100%). Diagnostic sensitivity for p-EBUS was 58.3%. Distal mucosa could be imaged with SpyGlass in 14/15 patients (93.3%). Mucosal appearance was described as abnormal in 7 out of the 15 subjects. Mean SpyGlass procedure time was 6.5 minutes. No direct complication was reported. Conclusion: Spyglass can be used in combination with p-EBUS to obtain images of the distal bronchial mucosa and peripheral pulmonary nodules. More patients will be needed to confirm whether mucosal appearance can be predictive of malignancy.

scholarly journals Diagnostic Yield of Combined Pulmonary Cryobiopsies and Electromagnetic Navigation in Small Pulmonary Nodules

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Olivier Taton ◽  
Benjamin Bondue ◽  
Pierre Alain Gevenois ◽  
Myriam Remmelink ◽  
Dimitri Leduc
Keyword(s):  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
Electromagnetic Navigation ◽  
Pet Ct ◽  
Endobronchial Ultrasonography ◽  
Risk Patients ◽  
Peripheral Pulmonary Lesions ◽  
Transbronchial Lung Cryobiopsy ◽  
Fdg Pet Ct ◽  
Small Pulmonary Nodules

Background. An increasing number of pulmonary nodules of unknown nature are detected as a result of screening by CT in high lung cancer risk patients. Objectives. The purposes of this study were to assess the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) combined with transbronchial lung cryobiopsy (TBLC) and to compare it with standard transbronchial biopsy (TBB) in pulmonary nodules of less than 2 cm in diameter. Methods. We prospectively included 32 patients (18 men and 14 women, mean age 68 ± 9 years) with nodules of less than 2 cm in diameter and no metastasis at 18FDG PET-CT. The nodule position was determined by ENB, radial endobronchial ultrasonography miniprobe, and fluoroscopy. Eight samples were obtained, six by TBB and two by TBLC. Results. Nodule diameter averaged 16 ± 3 mm. Twenty-five nodules were malignant and 18 were surgically resected. Surgery was avoided in four patients as the biopsies revealed a benign disease. The samples obtained by TBLC were five times larger than those by TBB. The diagnostic yields of TBLC and TBB were 69% and 38%, respectively (p=0.017). Adverse events consisted in 15 mild or moderate bleedings and one pneumothorax. Conclusions. In the setting of peripheral pulmonary lesions of less than 20 mm in diameter, ENB-combined TBLC is feasible and safe, provides larger samples, and has higher diagnostic yield than TBB.

scholarly journals Prospective multicentre study on the safety and utility of transbronchial lung cryobiopsy with endobronchial balloon

2020 ◽  
Vol 6 (2) ◽  
pp. 00008-2020
Author(s):  
Minoru Inomata ◽  
Naoyuki Kuse ◽  
Nobuyasu Awano ◽  
Mari Tone ◽  
Hanako Yoshimura ◽  
...  
Keyword(s):  
Adverse Events ◽  
Safety Profile ◽  
Respiratory Diseases ◽  
Diagnostic Yield ◽  
Balloon Catheter ◽  
Serious Adverse Events ◽  
Lung Cancers ◽  
End Point ◽  
Diffuse Parenchymal Lung Diseases ◽  
Transbronchial Lung Cryobiopsy

Transbronchial lung cryobiopsy (TBLC) has been increasingly utilised to diagnose diffuse parenchymal lung diseases (DPLDs) and lung cancers; however, TBLC protocols have not yet been standardised and the rate of complications associated with this procedure vary widely. Therefore, this prospective multicentre observational study investigated the safety and utility of the TBLC technique in patients with diffuse and localised respiratory diseases.This study was conducted at multiple medical centres in Japan between July 2018 and April 2019. The study's primary end-point was the rate of severe or serious adverse events associated with TBLC. Adverse events included bronchial bleeding, pneumothorax, pneumonia, respiratory failure, and an acute exacerbation of interstitial pneumonia. Adverse events were graded according to severity. During the TBLC procedure, an endobronchial balloon catheter for bronchial blockade was used in all patients. Pathological confidence and quality of specimens were categorised into three groups.A total of 112 patients were included. Neither severe nor serious adverse events were identified; therefore, the primary end-point was met. Nineteen patients (17%) experienced no bronchial bleeding. Mild or moderate bronchial bleeding was identified in 67% and 16% of patients, respectively. Mild pneumothoraces were identified in four patients (3.6%). The safety profile in patients aged ≥75 years was not significantly different from younger patients. Definite or probable pathological diagnoses were made in 84.9% of patients.This TBLC protocol with routine use of an endobronchial balloon had an acceptable safety profile and diagnostic yield in patients, including elderly ones, with diffuse and localised respiratory diseases.

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