Abstract
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 18FDG 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.
Highlights
Since the report of decreased lung cancer mortality associated with screening trials in subjects at high lung cancer risk [1], the number of chest CT scans performed for the detection of lung cancer increased dramatically
Eberhardt et al [4] reported that the diagnostic yield of bronchoscopy could be improved up to 88% by combining electromagnetic navigation bronchoscopy (ENB) with endobronchial ultrasonography (EBUS) in order to guide transbronchial biopsy (TBB)
Among the 29 patients in whom both transbronchial lung cryobiopsy (TBLC) and TBB could be obtained, their overall diagnostic yield was 69% (20/29) and 38% (11/29), respectively (p=0.017)
Summary
Since the report of decreased lung cancer mortality associated with screening trials in subjects at high lung cancer risk [1], the number of chest CT scans performed for the detection of lung cancer increased dramatically. Eberhardt et al [4] reported that the diagnostic yield of bronchoscopy could be improved up to 88% by combining electromagnetic navigation bronchoscopy (ENB) with endobronchial ultrasonography (EBUS) in order to guide transbronchial biopsy (TBB). An increasing number of pulmonary nodules of unknown nature are detected as a result of screening by CT in high lung cancer risk patients. 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. 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
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