Diagnostic yield of transbronchial cryobiopsy in peripheral lung lesions

Abstract

Objectives: To study the diagnostic yield and safety of image-guided transbronchial lung cryobiopsy (TBC) and forceps biopsy (TBF) in peripheral lung lesions. Methods: Patients with peripheral lung lesion either mass/nodule or persistent consolidation detected by chest CT were evaluated for bronchoscopy and TBC. Echocardiography, bleeding profile, and arterial blood gases were performed as patients with persistent hypoxemia, systolic pulmonary artery pressure (PAP)>45 mmHg and coagulopathy were excluded. The procedure was performed under general anaesthesia and bronchoscopy was introduced through endotracheal tube. Bronchoalveolar lavage, TBF followed by TBC using 2.4 mm cryoprobe under fluoroscopic guidance were performed to all patients. All the samples were analysed histopathologically. Results: Eleven males and 5 females (55.3±14 years, SpO2 93±3.1% and PAP 30.3±2.9mmHg) were enrolled. The lesion as described by CT was peripheral mass in 68.8%, macro-nodules 18.8%, cavity 6.3% and consolidation 6.3%. 50% of lesions were either in left upper lobe or right lower lobe. TBC diagnostic accuracy was 75% with sensitivity of 55% versus 54.5% and 25% for TBF respectively. 25% were malignant, 12.5% suppurative, 6.3% pseudotumor and 6.3% focal interstitial inflammation. The size of TBC was 2.6±1.8 larger than TBF(p=0.038) with significant adequate(p=0.011) and preserved tissue architecture(p=0.047). Mild bleeding occurred in 27% after TBC vs. 6% after TBF with no pneumothorax in both (p=0.134). There were no significant relation between the site of lesion/CT description and yield of TBC (p>0.05). Conclusion: Image-guided cryobiopsy is safe with good diagnostic accuracy but low sensitivity in peripheral lung lesions.