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Original Research: Pulmonary Procedures |

A Randomized Controlled Trial of a Novel Sheath Cryoprobe for Bronchoscopic Lung Biopsy in a Porcine Model

Lonny B. Yarmus, DO, FCCP; Roy W. Semaan, MD; Sixto A. Arias, MD; David Feller-Kopman, MD; Ricardo Ortiz, BS; Hans Bösmüller, MD; Peter B. Illei, MD; Bernice O. Frimpong; Karen Oakjones-Burgess; Hans J. Lee, MD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aSection of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

bDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD

cInstitute of Pathology and Neuropathology, University of Tuebingen, Tuebingen, Germany

CORRESPONDENCE TO: Lonny Yarmus, DO, FCCP, Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, 1830 E Monument St, 5th Floor, Room 528, Baltimore, MD 21287


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):329-336. doi:10.1016/j.chest.2016.01.018
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Published online

Background  Transbronchial forceps biopsy (FBx) has been the preferred method for obtaining bronchoscopic lung biopsy specimens. Cryoprobe biopsy (CBx) has been shown to obtain larger and higher quality samples, but is limited by its inability to retrieve the sample through the working channel of the bronchoscope, requiring the bronchoscope to leave the airway for sample retrieval.

Objective  We evaluated a novel device using a sheath cryobiopsy (SCBx). This method allows for specimen retrieval through the working channel of the bronchoscope, with the scope remaining inside the airway.

Methods  This prospective, randomized controlled, single-blinded porcine study compared a 1.1-mm SCBx probe, a 1.9-mm CBx probe, and 2.0-mm FBx forceps. Assessment of histologic accessibility, sample quantity and quality, number of attempts to acquire and retrieve samples, cryoprobe activation time, fluoroscopy activation time, technical feasibility, and complications were compared.

Results  Samples adequate for standard pathologic processing were retrieved with 82.1% of the SCBx specimens, 82.9%% of the CBx specimens, and 30% of the FBx specimens. The histologic accessibility of both SCBx (P = .0002) and CBx (P = .0003) was superior to FBx. Procedure time for FBx was faster than for both SCBx and CBx, but SCBx was significantly faster than CBx (P < .0001). Fluoroscopy time was lower for both SCBx and CBx compared with FBx. There were no significant bleeding events.

Conclusions  SCBx is a feasible technique providing a higher quality lung biopsy specimen compared with FBx and can successfully be retrieved through the working channel. Human studies are needed to further assess this technique with additional safety data.

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