Conventional Biopsy Forceps Research Articles

The Diagnostic Yield of Bronchoscopic Cryobiopsy Compared to Conventional Forceps Biopsy in Endobronchial Tumors

The Diagnostic Yield of Bronchoscopic Cryobiopsy Compared to Conventional Forceps Biopsy in Endobronchial Tumors

Bronchoscopy Diagnostic Procedures in Central and Peripheral Lesions: A Narrative Literature Review

Bronchoscopy is a medical procedure that provides tracheobronchial visualization by placing a bronchoscope and is carried out by a competent doctor. Bronchoscopy is the main interventional procedure used in determining the diagnosis and staging of cancer patients and plays a role in interstitial lung disease and infections. The basic principle of bronchoscopy sampling is carried out with a combination of rinsing, brushing, needle aspiration and biopsy. Cryobiopsy has advantages over conventional forceps biopsy and electrocautery because it can produce tissue without artifacts. Navigated bronchoscopy techniques have facilitated peripheral lung tumor biopsies that have better diagnostic yield than conventional transbronchial biopsies. The combination of navigation bronchoscopy with an ultrathin bronchoscope for peripheral lesions is more effective than either modality.

Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study

BackgroundDifferential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy.MethodsThe study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure.Resultswe found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis.ConclusionLymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Comparison of Cryobiopsy and Forceps Biopsy in Suspected Lung Carcinoma Patients with Endobronchial Lesions: A Cross-sectional Study

Introduction: Forceps Biopsy (FB) is usually used to obtain tissue in endobronchial lesions through a flexible bronchoscope. The mean diagnostic rate of bronchoscopic FB is 74% in central tumours. A limitation of FB is the small tissue size and the occurrence of crush artifacts. In contrast, Cryobiopsy (CB) provides larger samples without such artifacts, which are crucial for accurate histopathological diagnoses. Aim: To compare the efficacy and safety of CB with FB in endobronchial mass lesions suspected of lung cancer. Materials and Methods: A cross-sectional study was conducted on suspected endobronchial mass lesions with suspicion of malignancy from October 2015 to March 2017. About 35 patients fulfilling the inclusion criteria were enrolled, and five of these 35 patients were excluded as they were diagnosed with benign lesions. Among these 30 patients, a flexible biopsy was obtained first followed by CB using the same endobronchial cryobiopsy. Data were analysed in terms of tissue viability, mean tissue size, diagnostic yield, complications, and histological diagnosis. Parameters were compared using the Chi-square test (χ2 test) and Fisher’s exact test. Results: The mean age of the study participants was 58.33±10.12 years. The mean±SD size (diameter) of tissue obtained by CB (0.73±0.47 cm) was higher than that of FB (0.23±0.08 cm) (p-value<0.001). The diagnostic yield obtained by CB was 96.7% compared to 70% in FB (p-value<0.005). Mild bleeding was seen in 86.7% of the CB group and in 60% of the FB group (p-value=0.019). None of the patients in the study experienced moderate or severe bleeding. Conclusion: CB emerges as a safe and dependable method, offering superior diagnostic outcomes compared to conventional FB with its capability to obtain larger biopsy samples and goodquality tissue while minimal bleeding. CB stands as a viable alternative to FB.

Elucidating diagnostic efficacy and safety of the procedure: cryobiopsy of endobronchial lesions with a flexible bronchoscope

When compared to conventional forceps biopsy, the use of a flexible cryoprobe allows for the sampling of endobronchial lesions, yielding well-preserved, circumferential, and substantial specimens, resulting in a higher diagnostic yield, as demonstrated in multiple studies. We evaluated the utility of cryobiopsy in the diagnosis of endobronchial lesions as well as its safety profile in this study. This retrospective study included 200 patients who underwent cryobiopsy for bronchoscopically visible endobronchial lesions between March 2016 and July 2022. Cryobiopsy was performed under conscious sedation using a flexible cryoprobe. Data on baseline patient characteristics, post-biopsy bleeding, and final histopathological diagnosis were collected. We evaluated the procedure's diagnostic yield and safety. The majority of the patients were male (84.5%) and the mean age of the patients was 56.96±13.64 years. In our study, the average size of cryobiopsy specimen was 6.8±1.2 mm. In 93% of cases, a definitive diagnosis was established; the most common diagnosis was squamous cell carcinoma of the lung (42.5%), followed by adenocarcinoma (18.5%) and small cell carcinoma (13.5%). Tuberculosis and sarcoidosis were reported in 2.5% and 1% of cases, respectively. In this study, 1% of patients had severe bleeding that required intubation and ICU admission, while 26% had moderate bleeding that was treated with cold saline and local epinephrine instillation. No mortality was reported in the study. Endobronchial cryobiopsy with a flexible bronchoscope is a safe procedure with a high diagnostic yield. This approach, which has a favorable safety profile, holds the promise of improving diagnostic and treatment outcomes in lung cancer and other benign lung diseases.

Comparison between thoracoscopic pleural cryobiopsy and conventional forceps biopsy in diagnosis of exudative pleural effusion: Assiut University experience

Abstract Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm2; P<0.001). The depth of pleural biopsy was evaluated by the presence of extrapleural fat cells, which were significantly higher in cryoprobe biopsy in comparison with forceps biopsy [21 (35%) vs. 11 (18.3%); P=0.03]. There were no significant complications or procedure-related deaths. Conclusions Cryobiopsy is a possible safe and effective alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper, and less number of biopsies. It was also found that cryoprobe biopsy had a better diagnostic yield, sensitivity, and accuracy.

Concordance between cryobiopsy and forceps biopsy specimens in assessment of immunohistochemistry staining for non-small cell lung carcinoma.

Cryobiopsy is recently being promoted for biopsy of tumors in the lung periphery in precision medicine for lung cancer; the obtained tissue samples have been reported to be more useful compared to those obtained using forceps, because of the larger volume and higher quality. However, the influence of freezing and thawing of tissues when performing cryobiopsy on the results of immunohistochemistry (IHC) has not been completely understood. In this study, consecutive patients who underwent diagnostic bronchoscopy with cryobiopsy for peripheral pulmonary lesions (PPLs) at our institution between June 2017 and November 2021 were reviewed retrospectively. Specimens of diagnosed cases of unresectable or recurrent non-small cell lung carcinoma (NSCLC) were selected. We compared the results of IHC assessment for programmed death-ligand 1 (PD-L1), human epidermal growth factor receptor 2 (HER2), and human epidermal growth factor receptor 3 (HER3) in cryobiopsy specimens versus conventional forceps biopsy specimens from the same site in the same procedure. Twenty-four of 40 patients were male (60%). The most frequent histologic type of cancer was adenocarcinoma (n=31, 77.5%), followed by NSCLC (n=4, 10%), squamous cell carcinoma (n=3, 7.5%), and others (n=2, 5%). The concordance rates of the tumor proportion scores (TPSs) for PD-L1, IHC score for HER2 and, IHC scores for HER3 were 85%, 72.5%, and 75%, respectively; the weighted kappa were 0.835, 0.637, and 0.697, respectively. Freezing and thawing associated with cryobiopsy had virtually no effect on the results of IHC. We suggest that cryobiopsy specimens would therefore be ideal for precision medicine and translational research.

Magnifying Endoscopy with Narrow-Band Imaging for Duodenal Neuroendocrine Tumors.

Duodenal neuroendocrine tumors (NETs) are rare subepithelial tumors that arise from the neuroendocrine cells beneath the epithelial layer. However, an accurate histopathological diagnosis is difficult when tissue samples are obtained using conventional endoscopic forceps biopsy alone. This study aimed to evaluate the magnifying endoscopy with narrow-band imaging (ME-NBI) findings of duodenal NETs. We retrospectively analyzed a database of 22 duodenal NETs from 21 patients who underwent ME-NBI between January 2011 and June 2022. The ME-NBI, endosonographic, and histopathologic findings of duodenal NETs were analyzed. Nineteen lesions were located in the bulb, two were located in the superior duodenal angle, and one was located in the second portion of the duodenum. Eighteen lesions (82%) had IIa morphology, and nine (41%) had central depression on the surface. On endoscopic ultrasonography, almost all lesions (20/22, 91%) were located in the second and/or third layers, and the median tumor size was 6 mm. During ME-NBI, the microsurface pattern was regular in 18 lesions (82%) and absent in 4 (18%). The microvascular pattern was regular in 17 lesions (77%), irregular in 4 (18%), and absent in 1 (5%). Thickened subepithelial vessels were observed in 15 (68%) lesions. There was no difference in tumor size according to the presence or absence of thickened subepithelial vessels (6.1 ± 1.8 mm vs. 5.9 ± 3.8 mm, p = 0.860). In conclusion, the characteristic ME-NBI findings of duodenal NETs were regular microsurface and microvascular patterns and the presence of thickened subepithelial vessels. These ME-NBI features may be useful for differentiating duodenal NETs from other duodenal subepithelial lesions.

Efficacy of combined transbronchial lung cryobiopsy and conventional forceps biopsy for lung malignancies: a prospective cohort study

There are few prospective reports of transbronchial lung cryobiopsy (TBLC) for malignant tumors in combination with forceps biopsy. We investigated the clinical parameters in which TBLC is superior to forceps biopsy. This is a prospective cohort study to analyse the efficacy of TBLC for suspected malignancy. TBLC was performed after brushing cytology and forceps biopsy, and the diagnostic yield for TBLC, brushing cytology, and forceps biopsy were examined. Adverse events were defined as those requiring additional procedures. Next-generation sequencing (NGS) analysis was performed in each case of non-small cell lung cancer. Of the 100 patients, malignancy was confirmed in 94 cases. The diagnostic yield for TBLC/forceps biopsy/brushing cytology was 86/81/82% respectively, while the diagnostic yield for all procedures combined was 94%. There was no significant difference in the diagnostic yield between TBLC and forceps biopsy. When comparing the biopsy site, the diagnostic yield for TBLC at the lower lobe was significantly higher than forceps biopsy (P < 0.01). Endobronchial ultrasonography imaging using a guide-sheath did not significantly differ in the diagnostic yield of TBLC. The success rate of NGS for TBLC specimens was 100% (26 cases). Adverse events included two cases of severe bleeding. TBLC of peripheral lesions may improve the diagnostic yield when combined with forceps biopsy and brushing cytology. The diagnostic yield of TBLC was higher at the lower lobes. Furthermore, TBLC provided sufficient specimen quality for NGS.

Diagnostic efficacy of cryobiopsy for peripheral pulmonary lesions with ground-glass opacity: a propensity score-matched analysis.

Peripheral pulmonary lesions (PPLs) with ground-glass opacity (GGO) are generally difficult to diagnose via bronchoscopy. Cryobiopsy, a recently introduced technique, provides quantitatively and qualitatively superior tissues compared with conventional biopsy methods and can improve diagnostic outcomes. However, its diagnostic accuracy has not been specifically investigated. Therefore, this study aimed to determine whether the combined use of cryobiopsy improves the diagnostic yield for PPLs with GGO. Consecutive patients who underwent bronchoscopy combined with radial endobronchial ultrasound and virtual bronchoscopic navigation for PPLs with GGO were retrospectively reviewed between June 2014 and May 2020. Cryobiopsy was introduced at our institution in June 2017. Patients who underwent only conventional biopsy (forceps and/or needle aspiration) between June 2014 and May 2017 were classified as the conventional group, whereas those who underwent cryobiopsy with or without conventional biopsy between June 2017 and May 2020 were categorized as the "cryo" group. The diagnostic performance of the two groups was compared using propensity score-matched analysis. Overall, 553 cases were identified, including 250 and 303 in the cryo and conventional groups, respectively. Propensity scoring was implemented to match lesion characteristics and intraprocedural findings, leading to the selection of 232 pairs of cases for each matched (m) group. The diagnostic yield in the m-cryo group was significantly higher than that in the m-conventional group [88.8% vs. 63.8%, odds ratio: 4.50 (95% confidence interval: 2.76-7.33), P<0.001]. Although the incidence of grade 2 and 3 bleeding in the m-cryo group was higher than that in the m-conventional group (40.5% vs. 8.6% and 2.6% vs. 0.4%, respectively; P<0.001), grade 4 bleeding was not reported. The combined use of cryobiopsy provides improved diagnostic yield for PPLs with GGO compared with conventional biopsy methods.

Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions.

Simple SummaryWith increasing interest in precision medicine for lung cancer, cryobiopsy is expected to improve the success rate not only for histological diagnosis, but also for next-generation sequencing. Rapid on-site evaluation (ROSE) is an immediate cytological evaluation performed during bronchoscopy. However, little is known about its clinical utility during cryobiopsy. We retrospectively reviewed the data of 63 consecutive patients who underwent cryobiopsy with ROSE of touch imprint cytology (ROSE-TIC) for solid peripheral pulmonary lesions. When the results of ROSE-TIC of each patient were compared directly with the histological findings of the corresponding specimen, the sensitivity, specificity, and positive and negative predictive values were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. Therefore, we believe that ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.Cryobiopsy enables us to obtain larger specimens than conventional forceps biopsy despite the caution regarding complications. This study aimed to evaluate the clinical utility of rapid on-site evaluation of touch imprint cytology (ROSE-TIC) during cryobiopsy of peripheral pulmonary lesions (PPLs). We retrospectively reviewed the data of consecutive patients who underwent cryobiopsy for solid PPLs between June 2020 and December 2021. ROSE-TIC was performed on the first specimen obtained via cryobiopsy and assessed using Diff-Quik staining. The results of ROSE-TIC for each patient were compared with the histological findings of the first cryobiopsy specimen. Sixty-three patients were enrolled in this study. Overall, 57 (90.5%) lesions were ≤30 mm in size and 37 (58.7%) had positive bronchus signs. The radial endobronchial ultrasound findings were located within and adjacent to the lesion in 46.0% and 54.0% of the cases, respectively. The sensitivity, specificity, and positive and negative predictive values of the ROSE results for histological findings of the corresponding specimens were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. In conclusion, ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.

Usefulness of Liquid-Based Cytology in Diagnosing Biliary Tract Cancer Compared to Conventional Smear and Forceps Biopsy.

Liquid-based cytology (LBC) has been shown to improve the diagnostic efficacy of brush cytology for thyroid, cervical and pancreatic cancer. To evaluate the diagnostic performance of LBC for biliary tract cancer, we compared it with conventional smears and forceps biopsies. A retrospective study was conducted of all consecutive patients who underwent brush cytology under ERCP from January 2010 to April 2020. The primary outcome was the diagnostic efficacy of conventional smears and LBC. The difference between the two groups was corrected using inverse probability weighting (IPW). The secondary outcome was the sensitivity and specificity of brush cytology and forceps biopsy. The secondary outcome was evaluated in patients who underwent both methods. Among 162 patients, conventional smears were performed in 70 patients and LBC was performed in 92 patients. In the primary analysis using IPW, the sensitivity of conventional smears and LBC was 56.00% and 78.26% respectively (P = 0.009). The specificity was 100% for both methods. The accuracy was 66.15% for conventional smears and 83.33% for LBC (P = 0.012). In the secondary analysis, the sensitivity of conventional smears versus forceps biopsies was 62.16% versus 78.38% (P = 0.034) and 81.16% for both LBC and forceps biopsies. The specificity of both cytological examination and forceps biopsies was 100%. Liquid-based cytology demonstrated better sensitivity and accuracy than conventional smears. Moreover, its diagnostic performance was close to that of forceps biopsies.

Transbronchial Cryobiopsy vs Conventional Forceps Biopsy in Lung Transplant Recipients Multicenter Study

<h3>Purpose</h3> Transbronchial biopsy is considered the gold standard in the diagnosis of acute cellular rejection after lung transplantation. There still remains the discussion in conventional forceps biopsy comparing to cryobiopsy in lung transplant recipients. This study aims to compare the diagnostic yield and potential complications in both procedures. <h3>Methods</h3> In retrospective multicenter study all transbronchial biopsies (TBBs) were evaluated since 2010 till 2019. Surveillance TBBs were performed in 1, 3, 6 and 12 months after lung transplantation. Additional diagnostic bronchoscopies were performed if clinically indicated. Pneumothorax was categorized as none, partial recovered without treatment and pneumothorax required inserting of chest drainage. Bleeding was predefined as none, mild bleeding requiring suction and instillation of cold saline solution and severe bleeding requiring additional instillation of adrenaline. TBBs were graded according to the International Society of Heart and Lung Transplantation (ISHLT) consensus guidelines for the diagnosis of lung allograft rejection. <h3>Results</h3> In 309 patients a total of 448 forceps biopsies and 573 cryobiopsies were performed. The incidence of pneumothorax was significantly (p<0,001) higher after forceps biopsies (9,2 % vs 3,3 %). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 80,4%/96,4%; mild 15,4%/2,4%; severe 4,2%/1.1%; p < 0.001). The mean size of cryo-specimen was five times larger than forceps-group samples. The diagnostic rate of acute rejection using cryobiopsy and forceps biopsy was similar A0 grade 36% vs 39%, A1 grade 46% vs 35%, A2 grade 14% vs 17,5%, A3-A4 grade 4% vs 8,5%. But evidently larger specimens from cryobiopsy catched the presence of bronchiolus in 51% compared with 8% from forceps samples which shows the major significance (p<0,001). <h3>Conclusion</h3> Transbronchial cryobiopsies compared to traditional forceps biopsies provided superior quality of the specimens with significantly higher capture of bronchiolus and lower rate of non-diagnostic samples which also enable potential possibility for futher evaluation of humoral and chronic rejection. Cryobiopsies reduce the number of specimens with acceptable complications.

Cryobiopsy as a reliable technique for the preoperative identification of micropapillary/solid components in early-stage lung adenocarcinoma

ObjectivesMicropapillary (MIP) and solid (SOL) subtypes of early-stage lung adenocarcinomas are associated with lymph node metastasis and local recurrence after limited resection. Preoperative identification of these components may influence the decisions of treatment strategy, additional lymph node evaluation, indication for limited resection, and extent of lymph node dissection. However, conventional biopsy specimens are insufficient for identifying these subtypes, especially MIP components. Cryobiopsy can collect larger tissue samples with fewer crush artifacts than conventional forceps biopsy, which would be helpful for detecting MIP/SOL components. Thus, this study aimed to analyze the feasibility of using cryobiopsy for MIP/SOL subtype detection. Material and methodsConsecutive patients who underwent surgery for clinical IA lung cancer following a preoperative diagnosis of adenocarcinoma by cryobiopsy at our institution between October 2017 and July 2019 were retrospectively examined. The concordance rate of MIP/SOL subtypes between the specimens obtained by cryobiopsy and surgery was investigated. ResultsIn total, 115 patients were evaluated. There were 26 (22.6%) and 14 (12.2%) patients with MIP and SOL subtypes, respectively. For concordance of MIP/SOL subtypes, the sensitivity was 65.7% (95% confidence interval [CI]: 57.7–65.7%). For the primary or secondary predominant patterns, a more satisfactory concordance rate of 72.2% (95% CI: 52.6–86.2%) was obtained. On assessing each subtype, high sensitivity was noted in SOL-predominant patterns (85.7%, 95% CI: 56.5%–96.0%) and MIP-secondary predominant patterns (83.3%, 95% CI: 45.8–97.0%). However, SOL-secondary predominant patterns revealed low sensitivity (0%, 95% CI, 0–38.2%). Overall, the MIP subtypes had higher sensitivity than the SOL subtypes (65.4% vs. 50.0%). ConclusionCryobiopsy could be reliable for identifying MIP/SOL components, especially the MIP component, in clinical stage IA adenocarcinomas.

Cryobiopsy in Lung Cancer Diagnosis-A Literature Review.

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-benefit profile, this novel method has the potential to improve the diagnosis, and therefore the management of lung cancer patients. The objective of this narrative review is to provide a comprehensive review of the recent data regarding the advantages of cryobiopsy and r-EBUS in lung cancer diagnosis.

The use of transbronchial cryobiopsy for diffuse parenchymal lung disease in critically ill patients with acute hypoxemic respiratory failure—A case series

Accurate diagnosis and management of undifferentiated diffuse parenchymal lung disease (DPLD) in critically ill patients is challenging. Transbronchial forceps biopsies have limited utility and surgical lung biopsies can be detrimental for critically ill patients. Transbronchial cryobiopsy (TBC) has shown increased diagnostic yield compared to conventional forceps biopsy in DPLD. However, TBC has not been studied in intensive care unit (ICU) patients. In this case series, we describe our experience with TBC for diagnosis of DPLD in ICU patients with acute hypoxemic respiratory failure. This case series includes critically ill patients who underwent TBC at two different tertiary care hospitals. Procedures were performed by the same interventional pulmonologist using the two therapeutic bronchoscopes with a 2.8-mm working channel, and a 1.9- or 2.4-mm cryoprobe. We performed TBC in 17 patients of which 12 (70.1%) were performed at bedside in ICU without fluoroscopic guidance. Pathological diagnosis was made in 15 (88%) patients which resulted in changes in management in most of these patients. Six patients (35.3%) developed pneumothorax post-procedure with 5 (29.4%) requiring a chest tube. Moderate bleeding was noted in one (6%) patient and no severe or fatal bleeding occurred. Our 30-day ICU mortality was 47% (n=8); however, no deaths were directly attributable to the procedure. TBC is a feasible technique with an acceptable complication rate and a fairly high histopathological yield in ICU patients with DPLD and acute hypoxemic respiratory failure. Appropriate diagnosis can be crucial in making management decisions for these patients.

Prospective Study of Comparison between Transbronchial Forceps Biopsy and Cryoprobe in the Diagnosis of Acute Rejection after Lung Transplantation

Purpose Transbronchial biopsy (TBB) using forceps is the standard procedure to establish the presence of allograft rejection after lung transplantation. However, inadequate tissue samples, high degree of interobservers variability and possible complications seems to prevent many centers in scheduling TBB in lung transplant follow-up.We aimed to compare histological quality of cryobiopsy (CB) and conventional forceps biopsy (FB) for sampling lung tissue in transplants recipients. Methods Eligible for inclusion were adults subjected to scheduled transbronchial biopsy at 3, 6 and 12 months after lung transplantation. A single pathologist classified the biopsy according to ISHLT scale.From January 2019 to August 2020, 54 consecutive transbronchial lung biopsies procedures were included in the study. All patients underwent at least 6 biopsies with forceps and 3 with cryoprobe in the same lung lobe. Clinical, functional data and histological findings were collected. Results The diagnostic yield of acute rejection using cryobiopsy is 100% compared to 79% using biopsy forceps. The difference in proportion is 0.20 [95% C.I: 0,11-0,29, p Conclusion Transbronchial cryobiopsy is effective for diagnosis of lung allograft rejection because it provides larger and more diagnostic lung parenchyma specimens than traditional forceps biopsies.

Comparison of the Diagnostic Performance of Novel Slim Biopsy Forceps with Conventional Biopsy Forceps for Biliary Stricture: A Multicenter Retrospective Study.

Novel slim biopsy forceps provide some technical advantages to facilitate a more accurate diagnosis, although we are not aware of any comparative studies. Therefore, we compared tissue acquisition and diagnostic accuracy between novel slim biopsy forceps and conventional biopsy forceps in cases with a biliary stricture. We reviewed 341 patients who underwent endoscopic retrograde cholangiopancreatography for the histological confirmation of biliary stricture at two tertiary hospitals between 2013 and 2020. The primary endpoint was the forceps’ diagnostic accuracies. We included 276 patients who underwent biopsy using the novel forceps (n = 130) or conventional forceps (n = 146). The novel forceps provided 81.7% sensitivity, 100.0% specificity, positive-predictive value (PPV) of 100.0%, and negative-predictive value (NPV) of 57.8%, with an accuracy of 85.4% when the diagnosis by endobiliary biopsy included suspected or positive malignancy. The conventional forceps provided 61.7% sensitivity, 100.0% specificity, PPV of 100.0%, and NPV of 36.1%, with an accuracy of 68.5%. Only novel forceps use was significantly associated with an accurate diagnosis (odds ratio: 2.70, 95% confidence interval: 1.52–5.00). There were no significant inter-group differences in the procedure-related rates of adverse events. Endobiliary biopsy using novel forceps offered better diagnostic performance and more acceptable procedure-related adverse events than conventional forceps.

Determining the Indeterminate Biliary Stricture: Cholangioscopy and Beyond.

Indeterminate biliary strictures (IDBS) continue to be an area of frustration for clinicians. Standard endoscopic retrograde cholangiopancreatography (ERCP) with conventional brush cytology and/or forceps biopsy has a low sensitivity for distinguishing benign from malignant biliary strictures. A delay in diagnosis of malignancy has consequences for subsequent therapy or surgery. In this article, we review current and emerging technologies that may aid in this diagnostic dilemma. Several technologies have been utilized in IDBS to establish a diagnosis which include peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound with fine needle aspiration, intraductal ultrasound, optical coherence tomography, fluorescence in situ hybridization, next generation sequencing, integrated molecular pathology, and DNA-image cytometry. While cholangioscopy and confocal laser endomicroscopy have become standards of care in expert centers for the evaluation of patients with IDBS, there are several endoscopic and molecular modalities that may also aid in establishing a diagnosis. Further head-to-head prospective diagnostic studies as well as cost-efficacy studies are needed.

Cryobiopsy In Flexi-Rigid Pleuroscopy in a Region with Low Mesothelioma Prevalence

Background: The use of conventional flexible forceps during flex-rigid pleuroscopy can be challenging when sampling hard and thickened pleura. Pleuroscopic cryobiopsy is an emerging field, with various early studies demonstrating good yield and minimal complications. Objectives: To review the authors’ early experience of pleuroscopic cryobiopsy in their centre and highlight its utility in the diagnosis of mesothelioma. Method: Six cases of undiagnosed pleural effusion that underwent pleuroscopic cryobiopsy via flexi-rigid pleuroscopy between July 2017 and June 2019 were retrospectively analysed. Results: The cohort had a median age of 59 years, consisting of two females and four males with a median age of 57 years. Mean (aggregate) tissue sample diameter was 9.2±1.9 mm. Cryobiopsy established a definitive diagnosis in all six cases: one case of malignant mesothelioma, one pleural tuberculosis, two small cell carcinomas, and two adenocarcinomas. Immunohistochemical staining was performed in all five of the malignant samples (100%). There were no major complications reported. Conclusions: Based on the case series, pleuroscopic cryobiopsy is a feasible adjunct to conventional forceps biopsy, a safe procedure in the authors’ setting, gives high diagnostic yield, and enables differentiation between the different causes of exudative pleural effusion. A large, prospective study is required to validate this retrospective series.