PURPOSE: The utility of cryobiopsy to sample both exophytic and macular endobronchial lesions has not been previously characterized. We wished to determine the adequacy, safety, and overall efficacy of cryobiopsy compared to traditional endobronchial forceps in the evaluation of endobronchial disease.
METHODS: We conducted a retrospective chart review of all patients with endobronchial lesions in whom both cryoprobe and forceps biopsies were obtained, from August 2008 through April 2010. All patients were included regardless of lesion location, lesion appearance, and diagnosis (benign versus malignant, if known). We compared tissue volumes (cm3) obtained by each sampling method using the Wilcoxon signed-rank test. Bleeding complications and final diagnosis were also tracked.
RESULTS: Cryobiopsy proved extremely safe, with only one complication reported (minor bleeding from an exophytic lesion that resolved spontaneously). Biopsy samples obtained with the cryoprobe (n=20) were significantly larger than those using forceps (0.1523 cm3 versus 0.0393 cm3, p= 0.0024). Cryobiopsy was equally effective in diagnosing malignant and benign lesions. Pathologically, the cryobiopsy samples had excellent tissue preservation, and were free of any significant artifact.
CONCLUSION: Cryobiopsy of endobronchial lesions appears extremely safe, and allows obtaining much larger samples when compared to forceps biopsy, which could provide for additional immunohistological and molecular testing. These cryobiopsies, combined with in-vivo cryotechnique for tissue analysis, may provide additional data regarding the microenvironment of tumors, something currently limited by artifact induced by the technique of immersion fixation followed by dehydration. Anecdotally, compared to the forceps, the cryoprobe facilitated sampling of lesions located parallel to the axis of the bronchoscope, proving to be safe and efficacious with both exophytic and macular lesions. Finally, cryobiopsies were useful for diagnosing both malignant and benign lesions.
CLINICAL IMPLICATIONS: The larger tissue volume and preservation of tissue characteristics obtained by cryobiopsy, versus traditional forceps, can provide for additional analyses that may improve diagnosis, treatment and outcomes.
DISCLOSURE: Michael Boyd, No Financial Disclosure Information; No Product/Research Disclosure Information