Diagnostic Yield and Safety of Bronchoscopic Lung Cryobiopsy in Evaluation of Lung Mass

Abstract

BackgroundA mass lesion in the lung is a common finding seen on chest radiology. The prognosis of patients with mass lesions in the lung is capricious as malignancy is a consideration. It is essential to diagnose the underlying aetiology at the earliest with minimally invasive procedures for prompt treatment of the case. Bronchoscopic lung cryobiopsy (BLC) is a newer interventional technique in pulmonary medicine for the diagnosis of mass lesions in the lung. Materials and methodsThis is a retrospective study of patients reporting to a tertiary care centre who were radiologically (by computed tomography scan of the chest) diagnosed with a mass lesion of the lung and who underwent BLC during the period from January 2018 to January 2021. We analysed the diagnostic yield of the technique defined as a positive tissue diagnosis after the histopathological examination (HPE) along with the safety of the procedure. ResultsDuring the above period, we evaluated 70 patients who were diagnosed radiologically with mass lesions of the lung and underwent BLC. We obtained tissue diagnoses for 66 cases and the result of four cases was inconclusive. The diagnostic yield of the BLC procedure was 94.29%. There was no mortality and complications were minimal bleeding and small pneumothorax. ConclusionBLC is a newer technique for obtaining lung tissue via a flexible bronchoscope obviating the need for open lung biopsy. The main advantage of the technique is providing larger tissue samples with minimal or no side effects without undergoing multiple procedures as compared to other bronchoscopic or surgical methods for obtaining a diagnosis from lung tissue. BLC is a safer and promising technique in diagnosing mass lesions of the lung with better yield.

Expert opinion on NSCLC small specimen biomarker testing — Part 1: Tissue collection and management

“…At least five endobronchial/transbronchial forceps biopsies should be obtained, and an additional five forceps biopsies or two cryo-biopsies could be considered to maximise tissue volume [9]. In a cryo-biopsy, the lung tissue is rapidly frozen prior to removal and the technique allows for larger samples with reduced artefacts compared with other techniques [17]. Cryo-biopsy has most commonly been used for diagnosing interstitial lung disease [25]; however, studies have shown that it is an efficient sampling technique for lung cancer [17,25].…”

“…In a cryo-biopsy, the lung tissue is rapidly frozen prior to removal and the technique allows for larger samples with reduced artefacts compared with other techniques [17]. Cryo-biopsy has most commonly been used for diagnosing interstitial lung disease [25]; however, studies have shown that it is an efficient sampling technique for lung cancer [17,25]. Endobronchial/transbronchial cryo-biopsy may increase histological and molecular detection rates of lung tumours when compared with other tissue sampling methods [26,27], and has been shown to provide a high diagnostic yield (94%) [17].…”

“…Cryo-biopsy has most commonly been used for diagnosing interstitial lung disease [25]; however, studies have shown that it is an efficient sampling technique for lung cancer [17,25]. Endobronchial/transbronchial cryo-biopsy may increase histological and molecular detection rates of lung tumours when compared with other tissue sampling methods [26,27], and has been shown to provide a high diagnostic yield (94%) [17]. However, endobronchial/transbronchial cryobiopsy for lung cancer is not commonly implemented in many countries.…”