Transbronchial Cryobiopsy Using the Ultrathin 1.1-mm Cryoprobe with Ultrathin Bronchoscopy under Radial Endobronchial Ultrasound Guidance for Diagnosis of Peripheral Pulmonary Lesions.

IF 3.5 3区医学 Q2 RESPIRATORY SYSTEM

Respiration Pub Date : 2024-01-01 Epub Date: 2024-03-12 DOI:10.1159/000538196

Franziska Hasselbring, Felix J F Herth, Mark Kriegsmann, Katharina Kriegsmann, Ralf Eberhardt

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引用次数: 0

Abstract

Introduction: Today, the increasing number of incidentally detected peripheral pulmonary lesions (PPLs) within and outside lung cancer screening trials is a diagnostic challenge. This fact encourages further improvement of diagnostic procedures to increase the diagnostic yield of transbronchial biopsy, which has been shown to have a low complication rate. The purpose of this study was to evaluate the safety and feasibility of a new ultrathin 1.1 cryoprobe that can be placed through an ultrathin bronchoscope (UTB) using fluoroscopy and radial endobronchial ultrasonography (rEBUS) navigation for assessing PPLs.

Methods: Thirty-five patients with PPL less than 4 cm in diameter were prospectively enrolled to receive transbronchial cryobiopsies (TBCBs) using the ultrathin 1.1-mm cryoprobe. Navigation to the PPL was accomplished with the UTB. Under rEBUS and fluoroscopy guidance up to 4 cryobiopsies were obtained. The sample sizes of the biopsies were compared to a historic collective derived from a 1.9-mm cryoprobe and standard forceps. The feasibility and safety of the procedure, the cumulative and overall diagnostic yield, and the cryobiopsy sizes were evaluated.

Results: After detection with the rEBUS, TBCB was collected from 35 PPLs, establishing a diagnosis in 25 cases, corresponding to an overall diagnostic yield of 71.4%. There was no difference in diagnostic yield for PPL <20 mm or ≥20 mm. All cryobiopsies were representative with a mean tissue area of 11.9 ± 4.3 mm2, which was significantly larger compared to the historic collective (p = 0.003). Six mild and four moderate bleeding events and 1 case of pneumothorax were observed.

Conclusions: Using the ultrathin 1.1-mm cryoprobe combined with an UTB for rEBUS-guided TBCB of PPL is feasible and safe. This diagnostic approach improves bronchoscopic techniques for diagnosing peripheral lung lesions and may contribute to improve diagnosis of lung cancer even in small PPL.

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在径向支气管内超声引导下，使用 1.1 毫米超薄冷冻探针和超薄支气管镜进行经支气管冷冻生物切片检查，以诊断肺部周围病变。

导言：如今，在肺癌筛查试验内外偶然发现的肺外周病变（PPL）越来越多，这是一项诊断挑战。这一事实促使人们进一步改进诊断程序，以提高经支气管活检的诊断率，经支气管活检已被证明具有较低的并发症发生率。本研究的目的是评估新型 1.1 超薄冷冻探针的安全性和可行性，该探针可通过超薄支气管镜，利用透视和径向 EBUS 导航来评估 PPL。使用UTB对PPL进行导航。在径向支气管内超声（rEBUS）和透视引导下，最多可进行 4 次冷冻活检。活检样本的大小与历史上使用 1.9 毫米冷冻探针和标准镊子进行的活检样本进行了比较。对手术的可行性和安全性、累积诊断率和总体诊断率以及冷冻活检样本大小进行了评估：使用 rEBUS 检测后，从 35 例 PPL 中采集了 TBCB，其中 25 例确诊，总诊断率为 71.4%。PPL<20毫米和≥20毫米的诊断率没有差异。所有冷冻活组织检查均具有代表性，平均组织面积为 11.9  4.3 平方毫米，与以往的集体检查相比明显增大（p=0.003）。观察到六次轻度和四次中度出血事件以及一例气胸：结论：使用 1.1 毫米超薄冷冻探针结合超薄支气管镜进行 PPL 的 rEBUS 引导 TBCB 是可行且安全的。这种诊断方法改进了支气管镜诊断肺部周围病变的技术，可能有助于改进对肺癌的诊断，即使是小的 PPL。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiration 医学-呼吸系统

CiteScore

7.30

自引率

5.40%

发文量

审稿时长

4-8 weeks

期刊介绍： ''Respiration'' brings together the results of both clinical and experimental investigations on all aspects of the respiratory system in health and disease. Clinical improvements in the diagnosis and treatment of chest and lung diseases are covered, as are the latest findings in physiology, biochemistry, pathology, immunology and pharmacology. The journal includes classic features such as editorials that accompany original articles in clinical and basic science research, reviews and letters to the editor. Further sections are: Technical Notes, The Eye Catcher, What’s Your Diagnosis?, The Opinion Corner, New Drugs in Respiratory Medicine, New Insights from Clinical Practice and Guidelines. ''Respiration'' is the official journal of the Swiss Society for Pneumology (SGP) and also home to the European Association for Bronchology and Interventional Pulmonology (EABIP), which occupies a dedicated section on Interventional Pulmonology in the journal. This modern mix of different features and a stringent peer-review process by a dedicated editorial board make ''Respiration'' a complete guide to progress in thoracic medicine.