Diagnostic Yield and Safety of Bronchoscopic Lung Cryobiopsy in Evaluation of Lung Mass (original) (raw)
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Cryobiopsy in Lung Cancer Diagnosis—A Literature Review
Medicina, 2021
Optimizing the diagnosis of lung cancer represents a challenge, as well as a necessity, for improving the low survival of these patients. Flexible bronchoscopy with forceps biopsy is one of the key diagnostic procedures used for lung tumors. The small sample size and crush artifacts are several factors that can often limit access to a complete diagnosis, therefore leading to the need of repeating the bronchoscopy procedure or other invasive diagnostic methods. The bronchoscopic cryobiopsy is a recent technique that proved its utility in the diagnosis of both endobronchial and peripheral lung tumors. In comparison with conventional forceps biopsy, studies report a higher diagnostic yield and a superior quality of the collected samples for both the histopathological and the molecular diagnosis of lung cancer. This method shows promising results in sampling lung tissue, alone, or in conjunction with fluoroscopy or radial endobronchial ultrasound (r-EBUS). With a good safety and cost-be...
Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement
Lung India
Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. Methodology: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on
Diagnostic Procedures for Lung Cancer According to Histological Types and Their Complications
Cyprus Journal of Medical Sciences, 2021
BACKGROUND/AIMS This study aimed to investigate if there are any differences between the diagnostic methods used in biopsy for lung cancer on the basis of the histological cell types. In addition, the contribution of bronchoscopic washing in the diagnosis of lung cancer and complications of flexible bronchoscopy and computed tomography (CT)-guided transthoracic needle biopsy (TNB) were also investigated. MATERIAL and METHODS The patients who were diagnosed with lung cancer pathologically were divided into two groups-bronchoscopic biopsy and CT-guided TNB. A comparison was made between the two groups according to the lung cancer cell type. Complication rates for both procedures were calculated. In addition, the contribution of bronchoscopic washing in the diagnosis of lung cancer was also investigated in patients who underwent bronchoscopy. RESULTS The study included 182 lung cancer patients, out of whom 106 patients were diagnosed by bronchoscopy and 76 patients were diagnosed by CT-guided TNB. There was no significant difference between the diagnostic approaches for adenocarcinoma (ADC) (p=.22). Small cell lung cancer (SCLC) and squamous cell carcinoma (SCC) were diagnosed more accurately by bronchoscopy than TNB (p=.01, p=.01, respectively). Bronchoscopic washing was found to be positive in 3 of the patients who had negative results with bronchoscopic biopsy. There were no major complications related to bronchoscopy. The total minor complication rate of bronchoscopy was found to be 11.3%. Pneumothorax was detected in 17% of patients undergoing TNB and the total complication rate of TNB was 19.7%. CONCLUSION SCLC and SCC were more accurately diagnosed by flexible bronchoscopy than TNB. Bronchoscopic washing contributed in the diagnosis of lung cancers. Flexible bronchoscopy was found to be much safer and associated with lower complication rates than CT-guided TNB.
Indian Journal of Pathology and Oncology, 2020
Background: The diagnostics in field of lung pathology with advent of bronchoscopic modalities comprises of BAL, BB, TBNA and TBLB. As the detection of malignancy at the earliest has taken so much importance in terms of treatment, prognosis and life expectancy use of cytological bronchoscopic modalities have come to an age and has promised early, accurate diagnosis and better patient outcome. In India as cases of lung diseases continues to increase, the use of cytology has a special role and in particular neoplastic lesions, infectious diseases and in ILD cases. TBNA technique should be encouraged due to its superior sensitivity. Materials and Methods: This study of BAL, BB, TBNA was done during routine diagnostic bronchoscopies at Government tertiary care centre and comparing their results with TBLB as gold standard. The study consisted of clinically diagnosed / suspected cases of lung lesions. The BAL/TBNA/BB cytology and TBLB specimens were taken by the pulmonologist. The clinica...
Transbronchial lung biopsy: the pathologist's point of view
The Clinical Respiratory Journal, 2014
Background and Aims: The efficacy of flexible cryoprobe in providing high-quality tissue specimens through bronchoscopy for making a diagnosis remains debatable. In this study, we have compared the diagnostic yield of cryoprobe with conventional sampling by forceps. Methods: Forty-one patients scheduled to undergo transbronchial lung biopsy (TBLB) in a pulmonary hospital in Tehran, Iran. Each patient underwent conventional TBLB and flexible cryoprobe TBLB (FCLB) sequentially. Specimen adequacy was defined by the presence of at least 50 alveolar spaces or a positive diagnostic yield. Adequacy of specimens, number and percentage of alveolar spaces without artifact, type of artifact, presence of bronchiolar structures and the diagnosis made based on the results of the two methods separately were compared.
IP innovative publication pvt. ltd, 2019
Background: Lung cancer is amongst the most commonly diagnosed major cancers. It is important to diagnose lung cancers as early as possible before the lesion has reached a visible and palpable tumor. This study was intended to find out efficacy of various diagnostic modalities in identifying pulmonary malignancies for easy and early diagnosis. Aims: To assess the efficacy of BAL and FNAC in suspected cases of pulmonary malignancy. Methodology: Prospective, observational study conducted in a tertiary care institute over a period of four years. 115 consecutive cases of suspected bronchogenic carcinoma were admitted. BAL and FNAC and biopsy were done to all the patients. Biopsy is taken as gold standard for comparison of BAL and FNAC to found the diagnostic efficacy in identifying pulmonary malignancy. Results: Out of the 107 cases of pulmonary malignancy, the most common type was Adenocarcinoma followed by squamous cell carcinoma and small cell carcinoma. Sensitivity of BAL was found to be 39.25% and FNAC was found to be 97.19%. Specificity was found to be 100% for both FNAC and BAL. Positive predictive value and negative predictive value was better with FNAC than that of BAL. Conclusions: Image guided FNAC of pulmonary lesions is a simple, safe, less expensive technique with low morbidity and leads to early and quick diagnosis when compared to trucut biopsy. In this study combination of BAL and FNAC can establish the diagnosis of bronchial carcinoma in most cases. Although histopathology remains the gold standard for diagnosis one can rely on cytology techniques for quick reporting of lung lesions. Keywords: BAL; Biopsy; FNAC; Pulmonary malignancy; Sensitivity; Specificity.
Journal of Thoracic Disease, 2016
Background: Recent advances in lung cancer treatment have changed the requirement for the amount and quality of biopsy specimens needed to characterize the tumor and select the best treatment. One adjunct to guide the bronchoscopist on the quality and quantity of specimens during bronchoscopic biopsies for the diagnosis of lung cancer is rapid on-site evaluation (ROSE) of cytological specimens. This technique has been shown to add to the diagnostic yield of bronchoscopy when obtaining adequate specimens for molecular profiling in lung cancer. ROSE is not available at all medical centers. We describe our initial experience using intra-procedural Frozen Section Evaluation (FROSE) of bronchoscopic biopsy specimens as an alternative to ROSE. Methods: A retrospective analysis of all interventional pulmonology cases using FROSE between February and July 2015 was performed. Results analyzed to evaluate the success in obtaining adequate specimens for molecular profiling. Results: A total of 88 interventional pulmonology cases employing a frozen section in at least one site were identified. In 94.3% of cases, a definitive diagnosis of benign or malignant was made. The concordance of frozen section diagnoses of benign or malignant was 100% with final diagnoses. Thirteen of the eighty-eight cases were ultimately sent for molecular analysis. Of these, twelve of thirteen (92.3%) cases were adequate to perform all ordered molecular testing. In all cases there was sufficient tissue to perform EGFR and ALK testing. Conclusions: In medical centers where ROSE may not be available, the use of FROSE by the local pathologist can be an effective technique to obtain adequate tissue and cytological samples for the diagnosis and molecular profiling of lung cancers. Further prospective study in bronchoscopic tissue sampling techniques to obtain the optimum quantity and quality of samples for molecular profiling of lung cancers for targeted treatments is needed.
Pulmonary Medicine, 2018
Background. An increasing number of pulmonary nodules of unknown nature are detected as a result of screening by CT in high lung cancer risk patients. Objectives. The purposes of this study were to assess the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) combined with transbronchial lung cryobiopsy (TBLC) and to compare it with standard transbronchial biopsy (TBB) in pulmonary nodules of less than 2 cm in diameter. Methods. We prospectively included 32 patients (18 men and 14 women, mean age 68 ± 9 years) with nodules of less than 2 cm in diameter and no metastasis at 18 FDG PET-CT. The nodule position was determined by ENB, radial endobronchial ultrasonography miniprobe, and fluoroscopy. Eight samples were obtained, six by TBB and two by TBLC. Results. Nodule diameter averaged 16 ± 3 mm. Twenty-five nodules were malignant and 18 were surgically resected. Surgery was avoided in four patients as the biopsies revealed a benign disease. The samples obtained by TBLC were five times larger than those by TBB. The diagnostic yields of TBLC and TBB were 69% and 38%, respectively (p=0.017). Adverse events consisted in 15 mild or moderate bleedings and one pneumothorax. Conclusions. In the setting of peripheral pulmonary lesions of less than 20 mm in diameter, ENB-combined TBLC is feasible and safe, provides larger samples, and has higher diagnostic yield than TBB.