A single-centre, randomised trial to compare diagnostic yield and safety between endobronchial cryobiopsy and endobronchial forceps biopsy procedure in patients with endobronchial lesions.

Abstract

Background: Flexible bronchoscopy is the diagnostic tool of choice to diagnose endobronchial lesions. Pathological samples can be harvested using various techniques, for example, forceps biopsy, brushing, washing, and recently cryobiopsy. The major drawbacks of forceps biopsy technique are (a) obtaining of smaller tissues and (b) presence of crush artefacts. This results in a significant failure rate. Cryobiopsy is the procedure where application of extreme cold to the pathological tissues is used for obtaining samples. As a cryoprobe allows procurement of larger biopsy samples which is devoid of any crush artefacts, these result in better histopathology, immunohistochemistry, and identification of specific genetic mutations.

Methods: The current trial tried to assess (i) the diagnostic yield of endobronchial cryobiopsies in comparison with endobronchial forceps biopsies and (ii) assess the duration of procedures and requirement of interventions to control bleeding, among 49 patients who had undergone forceps biopsy and 48 patients who had undergone cryobiopsy. The types of endobronchial lesions observed during bronchoscopic procedures were divided into (a) exophytic type and (b) infiltrative type. Biopsy interpretations were done by an expert pathologist.

Results: Cryobiopsy compared to forceps biopsy had a statistically significant higher diagnostic yield for diagnosis of overall endobronchial lesions (P < 0.0001) for both exophytic (P = 0.015) and infiltrative (P < 0.0001) growth. Cryobiopsy obtained larger tissue (P < 0.001). No statistically significant difference was found in the incidence of haemorrhage (P = 0.378) and duration (P = 0.173) between two procedures.

Conclusions: Cryobiopsies were more successful than forceps biopsies particularly for diagnosis of infiltrative growth. The complication rate was similar between the two procedures.