Safety and Performance of Transbronchial Cryobiopsy for Parenchymal Lung Lesions

Herth, Felix J.F.; Mayer, M; Thiboutot, Jeffrey; Kapp, C.; Sun, Jiayuan; Herth, Jonas; Kontogianni, Konstantina; Yarmus, Lonny

doi:10.1016/j.chest.2021.04.063

Cited by 37 publications

(51 citation statements)

References 24 publications

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“…It has been shown that compared with forceps biopsy, the rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures. This finding is consistent with recent studies, which showed that cryobiopsy was associated with the high risk of bleeding compared with other modalities ( 12 , 58 , 59 ). The safety profile of cryobiopsy has perhaps been the largest concern limiting its widespread adoption.…”

Section: Discussionsupporting

confidence: 93%

“…Previous cryobiopsy meta-analyses ( 53 – 55 ) showed that the rate of pneumothorax varied between 6 and 10%. A recent study by Herth et al ( 58 ) showed that TBCB had the pneumothorax rate of 6.6%, which is similar to standard forceps biopsy. A recent prospective cohort study ( 60 ) compared the effect of different cryoprobe types on the outcomes of TBCB found that the risk of pneumothorax can be influenced by procedure-related factors.…”

Section: Discussionmentioning

confidence: 61%

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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: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 61%

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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“…Interestingly, in our study, on univariable analysis, the presence of a bronchus sign and a concentric view both appear to be predictors of a central target hit. This result is consistent with prior literature supporting both bronchus sign and concentric rEBUS views being predictors of a diagnostic transbronchial biopsy [13,[15][16][17][18]. However, after multivariable analysis, this relationship does not maintain statistical significance with the primary driver of a successful hit being distance to target lesion.…”

Section: Discussionsupporting

confidence: 88%

Accuracy of Pulmonary Nodule Sampling Using Robotic Assisted Bronchoscopy with Shape Sensing, Fluoroscopy, and Radial Endobronchial Ultrasound (The ACCURACY Study)

et al. 2022

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Background: Despite recent advances in guided bronchoscopy, the yield of bronchoscopic biopsy of a peripheral pulmonary nodule (PPN) remains highly variable. Objective: The aim of the study was to evaluate which features of robotic assisted bronchoscopy (RAB) contribute to a successful biopsy in a cadaver model. Methods: A preclinical, prospective, single-blinded trial using a ventilated human cadaveric model assessed the successful puncture of implanted pulmonary nodules using various localization techniques with RAB. The different approaches included positioning the robotic catheter at predefined distances from the target nodule (<10 mm, 10–20 mm, 20–30 mm), bronchoscopist correction of divergence between the software virtual map and bronchoscopic view if observed, and impact of fluoroscopy and radial endobronchial ultrasound (rEBUS). The primary endpoint was a central target hit (defined as an inner 2/3 target puncture) verified by cone-beam computed tomography. Results: Thirty-eight RAB procedures were performed to target 16 PPNs. Median nodule size was 16.2 mm. All targets were located in the outer 1/3 of the lung with a bronchus sign in 31.3%. Central target hit rates were improved when the robotic catheter tip was closer to the nodule (<10 mm 68%, 10–20 mm 66%, 20–30 mm 11%, p < 0.001). Multivariable analysis confirmed the strongest predictor of a central target hit was robotic catheter distance to nodule (OR 0.89 per increase in 1 mm, p < 0.001), independent of the presence of a bronchus sign, divergence or concentric rEBUS view. Conclusions: Utilizing a RAB platform, closer proximity of the robotic catheter to the target nodule results in an increase in peripheral nodule biopsy success.

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“…The use of cryoprobes that provide larger tissue samples is well established for diagnosis of thoracic malignancy. Thus, the diagnostic yield of endobronchial biopsies of endoluminal lesions and of transbronchial cryobiopsies of periphery pulmonary nodules was found to be 90% and 93%, respectively [ 10 , 11 ]. When added to conventional sampling methods, cryobiopsy improved the diagnostic success rate in 8.6% of patients, and with low adverse events (1.2% severe bleeding and 0.8% pneumothorax events) [ 12 ].…”

Section: Group 1401: Interventional Pulmonologymentioning

confidence: 99%

ERS International Congress 2021: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly

et al. 2022

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This manuscript summarises the highlights from the virtual European Respiratory Society's “Clinical techniques, imaging and endoscopy” Assembly 14 presented at the 2021 European Respiratory Society International Congress. Cutting-edge innovative developments in both diagnostic approaches and therapeutic strategies in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases were presented on this year's interactive congress platform. In this manuscript, the Assembly 14 subgroups summarise the key take home messages given new research outcomes and place them in the context of the current knowledge.

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Safety and Performance of Transbronchial Cryobiopsy for Parenchymal Lung Lesions

Cited by 37 publications

References 24 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

Accuracy of Pulmonary Nodule Sampling Using Robotic Assisted Bronchoscopy with Shape Sensing, Fluoroscopy, and Radial Endobronchial Ultrasound (The ACCURACY Study)

ERS International Congress 2021: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly

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