Radial endobronchial ultrasound guided transbronchial cryobiopsy with fluoroscopy in the diagnosis of peripheral lung tumor: experience of the Hospital of Lithuanian University of Health Sciences Kauno Klinikos

Abstract

<b>Introduction:</b> Transbronchial cryobiopsy (TBCB) guided by radial endobronchial ultrasound (EBUS-R) with fluoroscopy is a novel technique in the diagnosis of peripheral lung tumor (PLT). <b>Aim:</b> To evaluate and compare the efficacy and safety of TBCB and transbronchial forceps biopsy (TBFB) in the diagnosis of PLT. <b>Methods:</b> Procedures were guided by EBUS-R with fluoroscopy under general anesthesia and intubation with the rigid bronchoscope. TBFB was performed for all patients with detectable PLT by EBUS-R and TBCB for those had no contraindications for cryobiopsy. Cryoprobes of 1.1, 1.7 and 1.9 mm (CRYO2 system, ERBE, Germany) with freezing time of 4-10 seconds and endobronchial blocker to stop bleeding of 5 and 7 Fr (Olympus) were used as well. <b>Results:</b> 78 patients (age 69.9±8,8 years, 50 (64.1%) males and 28 (35.9%) females) were enrolled with 78 TBFB and 36 TBCB performed. PLT size 3.1±1.8 cm. EBUS-R probe position: 30 cases (38.5%) within and 48 cases (66.7)% adjacent to PLT. Diagnostic yield of TBFB was 66.2 % (52/78 cases), TBCB was 80.6 % (29/36 cases) respectively (p&lt;0,05). TBFB diagnostic yield when EBUS-R probe was adjacent to PLT was 58.3% (28/48 cases), TBCB – 77,9% (17/23). TBFB diagnostic yield increased when EBUS-R probe was within the PLT 80.0% (24/30 cases), TBCB increased as well 92.3% (12/13 cases). No pneumothorax and severe bleeding were registered. <b>Conclusion:</b> TBCB is a safe procedure, which increase the diagnostic yield of PLT, especially when EBUS-R probe is within the target.