The value of using radial endobronchial ultrasound to guide transbronchial lung cryobiopsy

Abstract

Conventional transbronchial biopsies have a low diagnostic yield for interstitial lung disease (ILD) and peripheral lung nodules due to crush artifact and smaller tissue samples. Transbronchial lung cryobiopsies (TBLC) circumvent these drawbacks but are associated with higher incidence of complications including life threatening airway bleeding and pneumothoraces. Radial probe endobronchial ultrasound (RP-EBUS) can be used during the TBLC for assessing the biopsy site prior to the cryobiopsy to avoid vasculature and to decrease the risk of complications. There is no standardized protocol for this technique and the available literature mostly consists of single center case reports/series. The aim of this review is to investigate the existing literature for RP-EBUS assisted TBLC for diagnosing both ILD and peripheral lung nodules. We will describe the techniques used and compare the diagnostic yield and complication rates with other modalities.

The Safety and Feasibility of Radial Endobronchial Ultrasound-guided Transbronchial Cryobiopsy in Diffuse Pulmonary Infiltrate Diseases

“…This is consistent with previous studies which showed a better diagnostic rate with TBLC compared to TBLB in patients with ILD, but not in patients with pulmonary nodules/masses. [6,11,18] This may be because cryobiopsy provided a larger specimen than forceps biopsy in this study (40 mm 3 vs 6 mm 3 ; p < 0.001), which is also consistent with a previous study. [17] In the current study, five patients had non-specific pathological findings of chronic inflammation based on the forceps biopsy, and were ultimately diagnosed as having organizing pneumonia after adding cryobiopsy.…”

“…[17] For patients with PPLs, the complication rate of TBLC has been reported to be relatively lower compared to patients with ILD. [11] The purpose of combining R-EBUS guidance with TBLC is not only to reduce the bleeding rate by locating lung parenchyma without adjacent major vessels, but also to decrease the occurrence of pneumothorax. Gnass et al reported a case series of 20 patients with ILD who underwent R-EBUS-guided TBLC, in which only one patient (1/20) had minor bleeding and one patient (1/20) had pneumothorax.…”

“…[9,10] The diagnostic rate of PPLs with R-EBUS with TBLC has been reported to range from 62.5% to 83%, with a moderate bleeding rate of 3% to 32%. [11] Most previous studies have been limited by the lack of a control group. Therefore, we conducted this retrospectively study of 30 patients with DPLDs or PPLs who underwent R-EBUS-guided TBLB followed by R-EBUS-guided TBLC.…”

Pulmonary Nodular Lymphoid Hyperplasia in the Eye of Radial Endobronchial Ultrasound

“…However, the emergence of bronchoscopic-guiding modalities such as virtual bronchoscopic navigation (VBN) has improved navigation through the airways, with reported biopsy success rates ranging 67 to 84% [7]. Cryobiopsy has been reported as a valid surrogate for surgical lung biopsy in patients with lymphoproliferative disease [8]. Single-center studies have demonstrated superior yields and larger tissue sizes in the diagnosis of peripheral lung lesions [9], with one single-center study demonstrating a yield of up to 74.2% [10].…”

“…Cryobiopsy has been reported as a valid surrogate for surgical lung biopsy in patients with lymphoproliferative disease [8]. Single-center studies have demonstrated superior yields and larger tissue sizes in the diagnosis of peripheral lung lesions [9], with one single-center study demonstrating a yield of up to 74.2% [10]. This method could potentially facilitate bronchoscopic therapeutic options to treat peripheral pulmonary lesions in the future for patients deemed not suitable for surgical intervention.…”