Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis

Pb, Sryma; Mittal, Saurabh; Madan, Neha Kawatra; Tiwari, Punit; Hadda, Vijay; Guleria, Randeep; Madan, Karan

doi:10.1016/j.pulmoe.2020.12.006

Cited by 49 publications

(50 citation statements)

References 29 publications

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“…The present meta-analysis addressed limitations of previous meta-analyses ( 13 , 53 – 55 ). Sryma et al ( 56 ) reported no significant difference in diagnostic yield between cryobiopsy and forceps biopsy, but in our study, we did find significant difference between the two modalities for the diagnosis of PPLs. In pooled analysis, they included one single-arm study ( 57 ) which may have affected the overall result.…”

Section: Discussioncontrasting

confidence: 85%

Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated Systematic Review and Meta-Analysis

et al. 2022

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BackgroundCryobiopsy has emerged as a novel alternative to conventional forceps biopsy for the diagnosis of interstitial lung diseases (ILDs), lung tumors, and peripheral pulmonary lesions (PPLs). This study aims to compare cryobiopsy and forceps biopsy for the diagnosis of these lung pathologies with respect to efficacy and safety by performing a meta-analysis of updated evidence.MethodsA number of databases, such as PubMed, Embase, Web of Science, the Cochrane Library, OVID, CNKI, and Wanfang database, were searched for eligible studies. Randomized and non-randomized comparative studies investigating the efficacy and safety of cryobiopsy vs. forceps biopsy for lung pathologies were included. Pooled results were calculated as an odds ratio (OR) or standardized mean difference (SMD) with 95% CI.ResultsA total of 39 studies, such as 9 RCTs with 3,586 biopsies (1,759 cryobiopsies and 1,827 flexible forceps biopsies) were analyzed. Cryobiopsy was associated with a significant increase in the diagnostic rates of ILDs (OR, 4.29; 95% CI, 1.85–9.93; p < 0.01), lung tumors (OR, 3.58; 95% CI, 2.60–4.93; p < 0.01), and PPLs (OR, 1.70; 95% CI, 1.23–2.34; p < 0.01). Cryobiopsy yielded significantly larger specimens compared with flexible forceps biopsy (SMD, 3.06; 95% CI, 2.37–3.74; p < 0.01). The cryobiopsy group had a significantly higher (moderate to severe) bleeding risk than the forceps group (OR, 2.17; 95% CI, 1.48–3.19; p < 0.01). No significant difference was observed in the incidence of pneumothorax between the groups (OR, 0.90; 95% CI, 0.44–1.85; p = 0.78).ConclusionOur results demonstrate that cryobiopsy is a safe and efficacious alternative to conventional forceps biopsy.

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Section: Discussioncontrasting

confidence: 85%

Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated Systematic Review and Meta-Analysis

et al. 2022

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“…The cryobiopsy method, which uses the cryoadhesive effect (the Joule-Thomson effect) [18], can easily collect large amounts of appropriate tissue samples, and thus, can be used in bronchoscopy procedures for the diagnosis of PLL [8]. Previous meta-analysis showed that there was no difference in the pooled diagnostic yield between cryobiopsy and forceps biopsy for PLLs when combined with RP-EBUS (77% and 72%, respectively) [9], whereas, Matsumoto et al recently reported that the diagnostic yield of conventional TBB and sequential TBC using a 1.9-mm cryoprobe for PLLs (irrespective of lesion size) was found to be up to 90% [11]. However, 1.9-mm cryoprobe is not flexible enough to advance to bronchi with an acute angle, such as both upper lobes.…”

Section: Cancer Research and Treatment (Crt) 10mentioning

confidence: 99%

“…The combination of RP-EBUS and transbronchial cryobiopsy (TBC) for PLLs is considered one of the alternatives to improve the performance of conventional TBB using RP-EBUS [8][9][10]. A recent study regarding the additional TBC using a 1.9-mm diameter cryoprobe after forceps biopsy demonstrated promising results [11].…”

Section: Introductionmentioning

confidence: 99%

The Additive Impact of Transbronchial Cryobiopsy Using a 1.1-mm Diameter Cryoprobe on Conventional Biopsy for Peripheral Lung Nodules

Kim

Mok

et al. 2023

Cancer Res Treat

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The diagnostic yield of transbronchial biopsy (TBB) using radial probe endobronchial ultrasound (RP-EBUS) is 71%, which is lower than that of transthoracic needle biopsy. We investigated the performance and safety of sequential transbronchial cryobiopsy (TBC) using a novel 1.1-mm diameter cryoprobe, after conventional TBB using RP-EBUS for the diagnosis of peripheral lung lesions (PLLs). Materials and MethodsFrom April 2021 to November 2021, 110 patients who underwent bronchoscopy using RP-EBUS for the diagnosis of PLL ≤ 30 mm were retrospectively included in our study. All records were followed until June 2022. ResultsThe overall diagnostic yield of combined TBB and TBC was 79%, which was higher than 61% of TBB alone (p=0.005). The diagnostic yield of sequential TBC was 65%, which increased the overall diagnostic yield by 18%. The surface area of tissues by TBC (mean area, 18.5 mm 2 ) was significantly larger than those of TBB by 1.5mm forceps (3.4 mm 2 ; p < 0.001) and 1.9-mm forceps (3.7 mm 2 ; p=0.011). In the multivariate analysis, PLLs with the longest diameter of ≤ 22 mm were found to be related to additional diagnostic benefits from sequential TBC (odds ratio, 3.51; 95% confidence interval, 1.043-11.775; p=0.042). Complications were found in 10% of the patients: pneumothorax (1%), infection (1%), and significant bleeding (9%). None of the patients developed any life-threatening complications. ConclusionSequential TBC with a 1.1 mm cryoprobe improved the performance of conventional TBB using RP-EBUS without serious complications.

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“…In fact, none of the 60 patients who underwent wedged-tube cryobiopsy in the outpatient setting needed unplanned hospital admission due to complications. The cryobiopsy diagnostic yields for localized lesions and diffuse lung disease range from 67 to 92% [ 24 ], and 40% to 95% [ 2 ], respectively. Many factors (e.g., size, presence of the bronchus sign, and lesion location and type) affect diagnostic yield; thus, we could not compare the diagnostic yields in the current study to published data, although ours seemed acceptable.…”

Section: Discussionmentioning

confidence: 99%

Thin bronchoscopic cryobiopsy using a nasobronchial tube

et al. 2022

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Background Transbronchial lung cryobiopsy is useful when diagnosing lung lesions. However, prevention of associated bleeding complications is essential. This study aimed to evaluate the safety and efficacy of our novel bronchoscopic cryobiopsy technique, which uses a long nasobronchial tube to prevent blood flooding the central airway. Methods Patients with localized or diffuse lung lesions were prospectively enrolled and underwent cryobiopsy using a 1.9 mm diameter cryoprobe and a 4.0 mm diameter thin bronchoscope under conscious sedation. For cryobiopsy, a long silicone tube (inner diameter, 5.0 mm) was advanced through the nose to the target bronchus, then wedged to drain blood under thin-tube bronchoscopic control. The primary endpoint was the frequency of bleeding complications. Results Of the 80 patients initially enrolled, 73 that underwent at least one cryobiopsy were ultimately included. Mild bleeding during cryobiopsy occurred in 58 patients (79.5%), but there was no moderate or severe bleeding. Other complications occurred in four patients (two pneumothorax, one pneumomediastinum, and one pneumonia). Tube dislocation was noted in eight patients (11%). Cryobiopsy specimens were significantly larger than forceps biopsy specimens (9.0 mm2 vs. 2.7 mm2, P < .001) and allowed specific diagnoses in 50 patients (68.5%). Conclusions Thin bronchoscopic cryobiopsy using a nasobronchial tube in consciously sedated patients is safe and effective. Trial registration Date of registration: 24/06/2019. UMIN-Clinical Trials Registry; Identifier: UMIN000037156 https://www.umin.ac.jp/ctr/index.htm

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Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis

Cited by 49 publications

References 29 publications

Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated Systematic Review and Meta-Analysis

Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated Systematic Review and Meta-Analysis

The Additive Impact of Transbronchial Cryobiopsy Using a 1.1-mm Diameter Cryoprobe on Conventional Biopsy for Peripheral Lung Nodules

Thin bronchoscopic cryobiopsy using a nasobronchial tube

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