Efficacy of combined transbronchial lung cryobiopsy and conventional forceps biopsy for lung malignancies: a prospective cohort study

Abstract

There are few prospective reports of transbronchial lung cryobiopsy (TBLC) for malignant tumors in combination with forceps biopsy. We investigated the clinical parameters in which TBLC is superior to forceps biopsy. This is a prospective cohort study to analyse the efficacy of TBLC for suspected malignancy. TBLC was performed after brushing cytology and forceps biopsy, and the diagnostic yield for TBLC, brushing cytology, and forceps biopsy were examined. Adverse events were defined as those requiring additional procedures. Next-generation sequencing (NGS) analysis was performed in each case of non-small cell lung cancer. Of the 100 patients, malignancy was confirmed in 94 cases. The diagnostic yield for TBLC/forceps biopsy/brushing cytology was 86/81/82% respectively, while the diagnostic yield for all procedures combined was 94%. There was no significant difference in the diagnostic yield between TBLC and forceps biopsy. When comparing the biopsy site, the diagnostic yield for TBLC at the lower lobe was significantly higher than forceps biopsy (P < 0.01). Endobronchial ultrasonography imaging using a guide-sheath did not significantly differ in the diagnostic yield of TBLC. The success rate of NGS for TBLC specimens was 100% (26 cases). Adverse events included two cases of severe bleeding. TBLC of peripheral lesions may improve the diagnostic yield when combined with forceps biopsy and brushing cytology. The diagnostic yield of TBLC was higher at the lower lobes. Furthermore, TBLC provided sufficient specimen quality for NGS.

Next‐generation sequencing using tissue specimen collected with a 1.1 mm‐diameter cryoprobe in patients with lung cancer

“…13 A recent study by Kinoshita et al reported a 100% success rate of NGS with TBC (n = 26). 25 Compared to the histological comparator of a 1.9 mm-diameter cryoprobe, the diagnostic yield of NGS testing in this study was not significantly different. In addition, the 1.1 mm-diameter cryoprobe is easy to insert into more peripheral regions and flexible enough to introduce where the bronchial bending angle is steep, such as the apical segment of the upper lobes.…”

“…Udagawa et al reported 90% and 75% success rates for whole exome and RNA sequencing, respectively ( n = 18) 13 . A recent study by Kinoshita et al reported a 100% success rate of NGS with TBC ( n = 26) 25 . Compared to the histological comparator of a 1.9 mm‐diameter cryoprobe, the diagnostic yield of NGS testing in this study was not significantly different.…”

“…After the cryo-technique was introduced in the field of lung cancer diagnosis for its advantage of obtaining larger biopsy samples, 23 NGS analysis using tissue samples obtained by TBC has recently been reported. 13,24,25 In all three studies involving NGS testing by cryo-techniques, a 1.9 mm-diameter cryoprobe was used. Arimura et al reported that the histological diagnostic yield of cryobiopsy was 87% in a relatively small number of patients (n = 23), and DNA sequencing was performed successfully in 17 cases.…”

“…After the cryo‐technique was introduced in the field of lung cancer diagnosis for its advantage of obtaining larger biopsy samples, 23 NGS analysis using tissue samples obtained by TBC has recently been reported 13,24,25 . In all three studies involving NGS testing by cryo‐techniques, a 1.9 mm‐diameter cryoprobe was used.…”

A Case of Lung Metastasis of Breast Cancer Diagnosed Using Ultrathin Bronchoscopic Cryobiopsy with a "Tube-wedging Method"

“…Recent studies have reported that cryobiopsy is practical, efficient, and reasonably safe for diagnosing PPLs [5][6][7] . Furthermore, cryobiopsy increases the diagnostic yield of ground-glass lesion 8) .…”