Radial Probe Ultrasound-Guided Cryobiopsy

Abstract

Fluoroscopy-guided transbronchial forceps biopsy has a low diagnostic yield in patients with radiographic suspicion of interstitial lung disease. Cryobiopsy has a higher diagnostic yield likely due to preserved lung architecture and larger biopsies; however, there is an increased risk of major airway bleeding and pneumothorax. Simultaneous use of endobronchial balloon blocker allows for containment of bleeding after cryobiopsy to the affected lobe. In the current article we describe use of radial ultrasound in identification of a target lung parenchyma without a major blood vessel adjacent to distal bronchi. After fluoroscopic marking of the selected airway a 3 second cryobiopsy was performed after localization of cryoprobe. Simultaneous use of radial ultrasound and fluoroscopy can possibly decrease bleeding complication associated with cryobiopsy in patients with suspected interstitial lung disease.

Confocal Laser Endomicroscopy as a Guidance Tool for Transbronchial Lung Cryobiopsies in Interstitial Lung Disorder

“…There are no previous studies which assess CLE as a guidance tool for cryobiopsy and only one report about ultrasound-guided cryobiopsy in ILD. In this case series blood vessels could be identified; however, identification of the pleura and areas with dense fibrosis were not described [16]. …”

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

“…Much of the technical evolution of cryobiopsy since its original description has centered on improving safety, particularly in protecting against major airway bleeding. Cryobiopsy is clearly capable of producing massive hemorrhage, as several authors have reported (45,48,64). As such, this procedure should only be performed by operators prepared for and adept at the management of major airway bleeding.…”

“…Post-biopsy bleeding was controlled with a 3-minute inflation of this balloon following each biopsy in 84 of 100 procedures (43). Berim et al, reported on their use of radial endobronchial ultrasound to detect significant vascular structures in prospective biopsy target regions in a limited series of six patients, without any major bleeds in this small cohort (48). Two series have piloted the use of two bronchoscopes to allow more rapid re-entry into the airway after each biopsy in lieu of endobronchial blocker use, with low rate of serious hemorrhage reported (44,46).…”

A lung full of Cheerios

“…Cryobiopsy safety could be further improved with R-EBUS visualisation and avoidance of major blood vessels 5. This case highlights the rare manifestation of lung adenocarcinoma as multiple Cheerio signs, with an added perspective of its appearance from the viewpoint of R-EBUS.…”