A pilot study of the ultrathin cryoprobe in the diagnosis of peripheral pulmonary ground-glass opacity lesions

Abstract

Background: It is very difficult to obtain samples of peripheral pulmonary ground-glass opacity lesions (GGOs) by traditional transbronchial biopsy. This study was conducted to evaluate the diagnostic efficacy and safety of transbronchial cryobiopsy (TBCB) of GGOs using a newly developed ultrathin cryoprobe with an outer diameter of 1.1 mm. Methods:We retrospectively analyzed 20 patients with 23 GGOs who underwent TBCB using the ultrathin cryoprobe from October 2018 to November 2019 in the Shanghai Chest Hospital. The TBCB procedure was performed under the guidance of virtual bronchoscopic navigation (VBN), electromagnetic navigation bronchoscopy (ENB), endobronchial ultrasound, and fluoroscopy. We collected the baseline information of participants, reported diagnostic yield and complications, and analyzed factors may have affected the diagnostic yield.Results: A total of 23 GGOs (12 pure GGOs, 11 mixed GGOs), with an average diameter of 21.58± 11.88 mm, underwent TBCB, and the diagnostic yield was 82.61% (19/23). Of the 19 GGOs diagnosed by TBCB, 12 were adenocarcinomas, 5 were inflammation, 1 was occupational interstitial lung disease, and 1 was a pulmonary meningothelial-like nodule. The remaining 4 undiagnosed lesions were confirmed to be adenocarcinomas by further analysis. The diagnostic yield was unchanged by factors including size (GGOs ≥20 mm, GGOs <20 mm), navigation (VBN, ENB), fluoroscopic visibility (visible, invisible), GGOcomponent (pure GGOs, mixed GGOs), and guide sheath (K-201, K203). There was no presentation of pneumothorax or severe hemorrhage. Conclusions:The ultrathin cryoprobe is feasible, safe, and has a high diagnostic yield in the diagnosis of pulmonary GGOs. There is vast potential for the ultrathin cryoprobe as a tool for the diagnosis of GGOs, especially for cases suspicious of early-stage lung cancer.

Mobile 3-dimensional (3D) C-arm system-assisted transbronchial biopsy and ablation for ground-glass opacity pulmonary nodules: a case report

“…As reported in previous studies, the diagnostic yield of transbronchial lung biopsy for GGO with guided bronchoscopy, such as EBUS and VBN, is only 57-69% (14,15). Ultrathin cryoprobe and multi-imaging modality-assisted bronchoscopic procedures are in great demand for improving the accuracy of biopsy for GGO lung nodules (16). Compared to other diagnostic methods, mobile 3D C-arm could provide real-time confirmation of "toolin-lesion", such that the device position could be adjusted accordingly based on 3D images of tool position with respect to lung nodules.…”

Diagnostic performance of cryobiopsy guided by radial-probe EBUS with a guide sheath for peripheral pulmonary lesions

“…Além disso, o tamanho das lesões foi um fator significativo que afetou o rendimento diagnóstico da criobiópsia, o que é consistente com um estudo que apresentou a maior série de dados sobre a CBTB. (4) Neste estudo, o rendimento diagnóstico da CBTB realizada com criossonda de 1,1 mm não foi significativamente maior que o da CBTB realizada com criossonda de 1,9 mm (78,4% vs. 76,8%; p = 0,84), o que é consistente com os achados de Lonny et al (8) Alguns estudos relataram que a criossonda de 1,1 mm é uma melhoria dramática em relação à criossonda de 1,9 mm no diagnóstico de lesões específicas (tais como nódulos em vidro fosco, lesões no lobo superior e lesões próximas da pleura) (25)(26)(27) ; o rendimento diagnóstico da criossonda de 1,1 mm é, portanto, maior que o de sondas maiores. Estudos anteriores sugerem que quando se usam uma criossonda ultrafina e uma bainha guia para a realização da criobiópsia, não é mais necessário remover em bloco o broncoscópio do paciente na amostragem de tecidos, e isso é benéfico para a realização de uma nova biópsia e para o monitoramento precoce de sangramentos.…”

Endobronchial removal of the peripherally located foreign body with the ultrathin bronchoscopy and ultrathin cryoprobe guided by a manual navigating method: A case report

“…While 1.1 mm ultrathin cryoprobe can easily bend and extend to the distal bronchus, and harvest several-fold amount of specimens by the movement of freezing and pulling out the probe, thus it is feasible, and has a high diagnostic yield in the peripheral pulmonary lesions. [6,13] Cryotherapy is also used in removal of foreign bodies, mainly used to eliminate granulation tissue surrounding the foreign body. [1] Mini-forceps was firstly tried in our case, and sometimes it was hard to open in such a small space or to clamp for that the chili stuck to the bronchial wall.…”