Feasibility of cryobiopsy specimen retrieval through standard guide sheath for peripheral pulmonary lesions without bronchoscope removal

Kho, Sze Shyang and Tan, Shirin Hui and Larry Ellee Nyanti and Chai, Chan Sin and Adam Malik, Ismail and Teck, Tie Siew (2024) Feasibility of cryobiopsy specimen retrieval through standard guide sheath for peripheral pulmonary lesions without bronchoscope removal. Journal of Bronchology & Interventional Pulmonology, 31 (4). pp. 1-7. ISSN 1944-6586

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URL: https://journals.lww.com/bronchology/fulltext/2024...

Abstract

Background: Transbronchial cryobiopsy is a promising technique for biopsy of peripheral pulmonary lesions (PPL). However, cryobiopsy specimen retrieval can pose problems due to the risk of bleeding during the blind period when the bronchoscope and cryoprobe are removed en bloc. Artificial airways and prophylactic balloon placement are risk-reducing measures, but the latter is challenging in upper lobe PPL. Specimen retrieval through standard guide sheath (GS) system without the need for bronchoscope removal may now be feasible with the ultrathin cryoprobe. Methods: Retrospective review of radial endobronchial ultrasound (rEBUS)-guided transbronchial cryobiopsy for PPL cases in which cryobiopsy specimen was retrieved through the GS over a 6-month period. Results: Twenty patients were included with an overall median age of 66.50 (IQR: 53.0 to 76.7). The median procedural time was 30 (IQR: 25.0 to 33.7) minutes. Median target size was 3.20 (IQR: 2.17 to 4.84) cm with 85% of lesions demonstrated “within” rEBUS orientation. Overall technical feasibility was 85% with median cryoactivation of 4.0 (IQR: 3.0 to 4.0) seconds. No specimen was retrieved in 3 patients. The diagnostic yield for forceps and cryobiopsy was 70% and 60%, respectively, and the combined diagnostic yield was 85% (P<0.01 vs. forceps biopsy). Median aggregate size for forceps and cryobiopsy was 8.0 (IQR: 5.3 to 10.0) and 4.5 (IQR: 2.3 to 7.0) mm respectively (P<0.01). No pneumothorax was reported and mild self-limiting bleeding was encountered in 30% of cases. Conclusion: Retrieval of cryoprobe through standard GS appears to be a safe and feasible method that can simplify the transbronchial cryobiopsy procedure and complement forceps biopsy in specific cases.

Item Type:	Article
Keyword:	Radial endobronchial ultrasound, Bronchoscopy, Interventional pulmonology, Cryobiopsy, Guide sheath
Subjects:	R Medicine > RA Public aspects of medicine > RA1-1270 Public aspects of medicine R Medicine > RC Internal medicine > RC31-1245 Internal medicine > RC581-951 Specialties of internal medicine > RC705-779 Diseases of the respiratory system
Department:	FACULTY > Faculty of Medicine and Health Sciences
Depositing User:	SITI AZIZAH BINTI IDRIS -
Date Deposited:	29 Nov 2024 13:02
Last Modified:	29 Nov 2024 13:02
URI:	https://eprints.ums.edu.my/id/eprint/42078

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