PURPOSE: Peripheral lung lesions (PLL) can pose a diagnostic problem since they are often difficult to reach and only insufficient material can be obtained by conventional transbronchial forceps biopsy (TBB). Endobronchial Ultrasound (EBUS) can be used for detection of PLL and in combination with a flexible cryoprobe (Erbe Medizintechnik, Germany) larger tissue samples can be taken. The purpose of this study was to evaluate the safety and feasibility of this technique.
METHODS: Patients with PPL up to 4 cm in diameter were enrolled prospectively in this study. After the lung lesion had been identified by radial EBUS we performed forceps as well as cryo biopsies under fluoroscopy guidance through a guide-sheath. The order of the techniques used was randomised. The pathologist was blinded towards the biopsy technique. We evaluated and compared the diagnostic yield and sample size as well as the complication rate of these techniques.
RESULTS: We randomised 39 patients and were able to reach the lesion with EBUS guidance in 31 patients. The final diagnosis of the 31 patients was malignant in 25 and benign in 6 cases. In 74 % of these patients we were able to make a definitive diagnosis with bronchoscopic sampling (23 of 31). In 19 cases the diagnosis was made with forceps as well as cryobiopsy, in 4 cases only through cryobiopsy. Samples obtained by cryobiopsy were significantly larger compared to forceps biopsies (11.17 mm2 vs. 4.71 mm2, p<0,001). Complications observed during the procedure were 1 moderate bleed after cryobiopsy treated endoscopically. No pneumthorax occurred.
CONCLUSIONS: Transbronchial cryobiopsy with EBUS-guidance is a safe technique and useful to obtain histological samples for diagnostic purposes.
CLINICAL IMPLICATIONS: By obtaining larger tissue samples, cryobiopsy can possibly improve the bronchoscopic diagnostic yield for peripheral lung lesions.
DISCLOSURE: The following authors have nothing to disclose: Ralf Eberhardt, Maren Schuhmann, Daniela Gompelmann, Korkut Bostanci, Philipp Schnabel, Felix Herth
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