Prospective multicentre study on the safety and utility of transbronchial lung cryobiopsy with endobronchial balloon

Abstract

Transbronchial lung cryobiopsy (TBLC) has been increasingly utilised to diagnose diffuse parenchymal lung diseases (DPLDs) and lung cancers; however, TBLC protocols have not yet been standardised and the rate of complications associated with this procedure vary widely. Therefore, this prospective multicentre observational study investigated the safety and utility of the TBLC technique in patients with diffuse and localised respiratory diseases.This study was conducted at multiple medical centres in Japan between July 2018 and April 2019. The study's primary end-point was the rate of severe or serious adverse events associated with TBLC. Adverse events included bronchial bleeding, pneumothorax, pneumonia, respiratory failure, and an acute exacerbation of interstitial pneumonia. Adverse events were graded according to severity. During the TBLC procedure, an endobronchial balloon catheter for bronchial blockade was used in all patients. Pathological confidence and quality of specimens were categorised into three groups.A total of 112 patients were included. Neither severe nor serious adverse events were identified; therefore, the primary end-point was met. Nineteen patients (17%) experienced no bronchial bleeding. Mild or moderate bronchial bleeding was identified in 67% and 16% of patients, respectively. Mild pneumothoraces were identified in four patients (3.6%). The safety profile in patients aged ≥75 years was not significantly different from younger patients. Definite or probable pathological diagnoses were made in 84.9% of patients.This TBLC protocol with routine use of an endobronchial balloon had an acceptable safety profile and diagnostic yield in patients, including elderly ones, with diffuse and localised respiratory diseases.

Comparison of adequacy between transbronchial lung cryobiopsy samples and endobronchial ultrasound‐guided transbronchial needle aspiration samples for next‐generation sequencing analysis

“…Several studies have used this procedure for the diagnosis of lung cancer along with pathological and molecular target testing. 14,19,20,[27][28][29][30] The success rate of TBLC samples for NGS analysis was high at 100% in the current study (fully adequate samples, 66.7%; partly adequate samples, 33.3%), and this result is similar to those of previous studies (90%-100%). 14,27 The current study showed that the median total area of tumor cells in TBLC samples was significantly greater than that in TBNA samples while the median area of the TBLC samples was significantly smaller than that of the EBUS-TBNA samples.…”

“…TBLC is a relatively novel procedure for obtaining lung tissue samples. Several studies have used this procedure for the diagnosis of lung cancer along with pathological and molecular target testing 14,19,20,27–30 . The success rate of TBLC samples for NGS analysis was high at 100% in the current study (fully adequate samples, 66.7%; partly adequate samples, 33.3%), and this result is similar to those of previous studies (90%–100%) 14,27 …”

“…However, considering our study results, TBLC should be more aggressively chosen over EBUS‐TBNA with consideration of NGS analysis. Previous studies have confirmed the safety of TBLC, as in the current study 14,19,20,29 . However, TBLC can only be performed in limited institutions because of the following reasons.…”

“…Transbronchial cryobiopsy (TBLC) has emerged as a useful procedure for lung biopsy because it can obtain samples with a larger volume than conventional procedures, such as TBLB 19,20 . In addition, most tumor cells in samples obtained via TBLC are not crushed, unlike those obtained via EBUS‐TBNA.…”

“…Transbronchial cryobiopsy (TBLC) has emerged as a useful procedure for lung biopsy because it can obtain samples with a larger volume than conventional procedures, such as TBLB. 19,20 In addition, most tumor cells in samples obtained via TBLC are not crushed, unlike those obtained via EBUS-TBNA. Either TBLC or EBUS-TBNA should be considered for lung cancer biopsy because most patients with lung cancer present with lesions in both lung fields as well as lymphadenopathy.…”