Cryobiopsy Research Articles

Transition from Transbronchial Forceps to Cryobiopsy After Lung Transplantation: A Single-Centre Experience

The gold standard for histological acute cellular rejection diagnosis is transbronchial forceps biopsy (FB), but in recent years, transbronchial cryobiopsy (CB) has been increasingly used. This study aims to compare the diagnostic rate and safety of FBs and CBs performed in two different periods. We retrospectively reviewed our case history for the two biopsy procedures: 251 FBs (223 for surveillance purposes and 28 for clinical indication) and 218 consecutive CBs (159 for surveillance purposes and 59 for clinical indication). All biopsies were scored according to the ISHLT criteria. Diagnostic yield was higher in the CB group for all the parameters considered: a grade of acute rejection (AR) was detected in 95.0% vs. 84.5% in the CB vs. FB groups (p < 0.001). The diagnostic rate of airway inflammation was 65.1% vs. 51.8% (p = 0.005), and 89.0% vs. 64.9% (p < 0.001) for chronic rejection. Pneumothorax requiring chest drainage occurred in 4% of the CB group and 3% of the FB group. Moderate and severe bleeding complicated CB and FB procedures in seven (3%) and three cases (1%), respectively. Transbronchial cryobiopsies improved the diagnostic yield in the monitoring of the lung allograft. The complication rate did not increase significantly in CBs vs. FBs.

Molecular Diagnosis of Lung Cancer (LC) In the ERA of Cryobiopsy (CB). A Literature Review

Molecular Diagnosis of Lung Cancer (LC) In the ERA of Cryobiopsy (CB). A Literature Review

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.

A Deceptive Tracheal Mass Mimicking Asthma

Primary tracheal tumours represent a rare malignancy characterized by a generally slow growth pattern. Notably, most cases are not of primary tracheal origin; instead, they arise from the local invasion of cancers originating in the lung, thyroid, or esophagus. Adenoid cystic carcinomas (ACCs) represent the second most prevalent primary tracheal tumours, making up around 10%–15% of cases. They generally have a more favourable prognosis than squamous cell carcinoma, the most frequently encountered type. Herein, we present the case of a 35-year-old female patient misdiagnosed and treated as asthma. The diagnosis was confirmed by cryo biopsy and histopathological examination. Surgical excision remains the treatment of choice. An active follow-up surveillance is needed to look for recurrence.

Cone-Beam Computed Tomography-Guided Cryobiopsy Combined with Conventional Biopsy for Ground Glass Opacity-Predominant Pulmonary Nodules

Introduction: Cryobiopsy (CB) using a 1.1-mm cryoprobe under fluoroscopic guidance is feasible and safe for diagnosis of ground glass opacity (GGO) lesions. However, the efficacy of CB combined with cone-beam CT (CBCT) for GGO-predominant pulmonary nodules remains elusive. Methods: We retrospectively studied patients who underwent CB combined with conventional biopsy under CBCT guidance for GGO-predominant pulmonary nodules with a consolidation-to-tumour ratio <50.0%. Results: A total of 32 patients with GGO-predominant pulmonary nodules were enrolled: 17 pure GGOs and 15 mixed GGOs. The mean lesion diameter was 15.81 ± 5.52 mm and the overall diagnostic yield was 71.9%. Seven lesions were diagnosed by CB alone, which increased the diagnostic outcomes by 21.9%. Diagnostic yields for CB, forceps biopsy (FB), brushing, and guide sheath flushing were 65.6%, 46.9%, 15.6%, and 14.3%, respectively. Univariate analysis revealed that positive computed tomography (CT) bronchus sign (p = 0.035), positive CBCT sign (p < 0.01), and CB-first biopsy sequence (p = 0.036) were significant predictive factors for higher diagnostic yield. Specimens obtained by CB had larger mean sample size (p < 0.01), lower blood cell area (p < 0.01), and fewer crush artefacts (p < 0.01) than specimens from FB. No severe bleeding or other complications occurred. Conclusion: CB using a 1.1-mm cryoprobe under CBCT guidance increased diagnostic yield for GGO-predominant pulmonary nodules based on conventional biopsy. Further, it provided larger and nearly intact samples compared with forceps.

Transbronchial Cryobiopsy Compared to Forceps Biopsy for Diagnosis of Acute Cellular Rejection in Lung Transplants: Analysis of 63 Consecutive Procedures.

Background: Acute cellular rejection (ACR) is a complication after lung transplantation (LTx). The diagnosis of ACR is based on histologic findings using transbronchial forceps biopsy (FB). However, its diagnostic accuracy is limited because of the small biopsy size and crush artifacts. Transbronchial cryobiopsy (CB) provides a larger tissue size compared with FB. Methods: FB and CB were obtained consecutively during the same bronchoscopy (February 2020–April 2021). All biopsies were scored according to the ISHLT criteria by three pathologists. Interobserver agreement was scored by the kappa index. We assessed the severity of bleeding and the presence of pneumothorax. Results: In total, 35 lung transplant recipients were included, and 126 CBs and 315 FBs were performed in 63 consecutive bronchoscopies. ACR (A1–A3, minimal–moderate) was detected in 18 cases (28.6%) by CB, whereas ACR was detected in 3 cases (4.8%) by FB. Moderate and severe bleeding complicated FB and CB procedures in 23 cases (36.5%) and 1 case (1.6%), respectively. Pneumothorax occurred in 6.3% of patients. The interobserver agreement was comparable for both CB and FB. Conclusions: CB provided an improved diagnostic yield for ACR diagnosis, leading to reclassification and changes in treatment strategies in 28.6% of cases. Prospective studies should better define the role of CB after LTx.

Cryo-Biopsy versus 19G needle versus 22G needle with EBUS-TBNA endoscopy.

Introduction: We have been using cryo-biopsy for endobronchial lesions for lung cancer diagnosis and debulking. Cryo-biopsy is also known to be an excellent tool for diagnosis of lung interstitial disease. Recently cryo-biopsy with the 1.1mm probe was used for lymphnode biopsy.Patients and Methods: 311 patients participated with lymphadenopathy and at least one lung lesion. The following tools were used for diagnosis; 22G Mediglobe Sonotip, 22G Medigolbe, 21G Olympus, 19G Olympus and 1.1mm cryo probe ERBE CRYO 2 system (3 seconds froze). A PENTAX Convex-probe EBUS was used for biopsy guidance.Results: Cell-blocks slices had a higher number in the 19G needle group (19G> Cryo Probe>22G Mediglobe Sonotip >21G Olympus >22G Mediglobe).Conclusion: Cryo biopsy of the lymphnodes is safe with the 1.1mm cryo probe. Further studies are needed in order to evaluate new probes and the technique specifications.

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.

Diagnostic Yield and Safety of Pleural Cryobiopsy during Medical Thoracoscopy to Diagnose Pleural Effusion. A Systematic Review and Meta-Analysis

ObjectiveCurrent evidence on the diagnostic yield and safety of pleural cryobiopsy (CB) is based on a series of heterogeneous studies with limited cohorts. A pooled analysis of these studies could improve the evidence and contribute to a better understanding of this new technique. MethodologyWe performed a systematic review and meta-analysis of published studies that included data on the yield and diagnostic safety of pleural CB compared with procedures performed using conventional flexible forceps. The heterogeneity of the analysis was evaluated by determining the I2 index, while study quality was measured with the QUADAS-2 tool. ResultsSeven studies involving 356 patients were used for the final evaluation. In 55.6%, the etiology of the pleural effusion was malignant, 61.1% of which were lung cancer. The diagnostic yield of pleural CB was 95% (95% CI 92-97) vs. 91% (95% CI 87-94) with conventional flexible forceps (P = .019). Mild bleeding was reported in 67% of CB procedures (95% CI 62-72) compared with 85% of conventional flexible forceps procedures (95% CI 79-90) (P < .001). CB specimens were larger, and fewer artifacts were detected. A pooled analysis of the detection of molecular changes could not be performed. Heterogeneity was moderate to high, although the quality of the studies was acceptable. ConclusionsPleural CB is a safe technique with a high yield for etiological diagnosis of pleural effusion, and larger specimens with fewer artifacts are obtained. Molecular determinations should be investigated in more depth.

IT IS TIME FOR ENDOBRONCHIAL THERAPY TO REPLACE SURGERY IN THE TREATMENT OF TYPICAL BRONCHIAL CARCINOID

SESSION TITLE: Lung Cancer Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To diagnose and treat benign endobonchial tumors by cryo procedure.To discover the efficacy of cryo approach in diagnosis and treatment of typic carcinoid , endobronchial hamartoma and papilomatosis METHODS: Patients were consulted at tertiary care between 2016-2019.Patients underwent Chest X Ray examinations, Chest computed tomography (CT) and flexible bronchoscopy, cryo biopsy. Eight of them resulted in typical carcinoid, three with endobronchial hamartomas and one with tracheal papillomatosis. The patients signed consensus to continue endobronchial treatment.All of them hadn’t adenopathy and hadn’t bronchial wall infiltration All patients underwent general anesthesia. bronchoflex tube was used for intubation through which we put the balloon for hemostasis by fibrobronchoscop. The patients underwent devitalisations, debulking and cryotherapy of endobronchial mass. All patients have been successfully treated with complete tumor resection and received cryotherapy to base implantation of tumor RESULTS: Twelve patients underwent endobronchial treatment with the combination of cryo therapy with electrocautery.Eight patient had typical carcinoid, three women and five men. Three patients were diagnosed with endobronchial hamartoma two men and one woman. One patient with tracheal papillomatosis. The median age of patients with carcinoid was 45 years. Only one patient had smoked. These patients were followed up with flexible bronchoscopy every three months, with Chest computed tomography and flexible bronchoscopy after 6 months and each year. Median follow-up was 27 months with Flexible bronchoscopy and Chest computed tomography . So far none of the patients have had local or remote relapses. CONCLUSIONS: According to these results and other authors, for typical carcinoid, it is time to replace surgery with less invasive and safer procedure, endobronchial therapy such as cryo approach. CLINICAL IMPLICATIONS: The main complication was hemorrhage which was managed with balloon and TA reduction. In all cases of significant haemorrhage,the patients have been with arterial blood pressure in the range of 130-140 mmHg. Lowering arterial blood pressure below 120 mmHg is a necessary action for the rapid management of hemorrhage. DISCLOSURES: no disclosure on file for Prof.Dr Perlat Kapisyzi; no disclosure on file for Fahri Kokici; no disclosure on file for ilir peposhi; No relevant relationships by Eritjan Tashi, source=Web Response No relevant relationships by Alma Teferici, source=Web Response no disclosure on file for Daniela Xhemalaj

Evaluation of Efficacy of a New Cryoprobe for Transbronchial Cryobiopsy: A Randomized, Controlled in vivo Animal Study

Background: Forceps biopsy (FB) is still the most popular procedure for the bronchoscopic sampling of lung tissue. However, it has limitations like inadequate sample size and crush artifacts. Cryobiopsy (CB) has been introduced to obtain bronchoscopic biopsies with improved diagnostic yield compared to FB. Limitations of CB are the need to retract the cryoprobe en bloc with bronchoscope because samples are larger than the working channel and the variations of the freezing power of the reusable CB (rCB). Therefore, 3 new disposable cryoprobes (dCB) have been developed with different outer diameters: 1.1 mm (CB11-S) that can be retracted through the working channel of the bronchoscope, 1.7 mm (CB17) and 2.4 mm (CB24n), respectively. Objectives: The aim was to evaluate the new cryoprobes with regard to feasibility, specimen area, specimen quality and complications. Methods: We compared biopsy samples of the new probes with those obtained by FB and by rCB in an in vivo (porcine) model. A flexible bronchoscope was used to perform biopsy at 4 different locations at the upper and lower lobes of the right and left lung, respectively. The biopsies were taken under fluoroscopic control. The biopsy tool and activation times were allocated randomly. Altogether 204 biopsy procedures were performed. Results: The sample quality of the dCB was superior to that of FB (all p < 0.05) and not significantly different to the rCB sample quality. Mean specimen sample area of all CB was significantly larger compared to FB (p < 0.05). The sample area of the small cryoprobe (CB11-S) was significantly smaller compared to the other CB probes (p < 0.05). No severe bleedings occurred. Pneumothoraces were detected in 3 of the 7 pigs. Conclusion: We conclude that CB with the new single-use instruments are feasible and represent a viable option to improve the diagnostic accuracy of histopathological evaluation compared to FB.

Rentabilidad diagnóstica y seguridad de la criobiopsia pleural durante la toracoscopia médica en el estudio del derrame pleural. Una revisión sistemática y metaanálisis

ObjectiveCurrent evidence on the diagnostic yield and safety of pleural cryobiopsy (CB) is based on a series of heterogeneous studies with limited cohorts. A pooled analysis of these studies could improve the evidence and contribute to a better understanding of this new technique. MethodologyWe performed a systematic review and meta-analysis of published studies that included data on the yield and diagnostic safety of pleural CB compared with procedures performed using conventional flexible forceps. The heterogeneity of the analysis was evaluated by determining the I2 index, while study quality was measured with the QUADAS-2 tool. ResultsSeven studies involving 356 patients were used for the final evaluation. In 55.6%, the etiology of the pleural effusion was malignant, 61.1% of which were lung cancer. The diagnostic yield of pleural CB was 95% (95% CI 92-97) vs. 91% (95% CI 87-94) with conventional flexible forceps (P=.019). Mild bleeding was reported in 67% of CB procedures (95% CI 62-72) compared with 85% of conventional flexible forceps procedures (95% CI 79-90) (P<.001). CB specimens were larger, and fewer artifacts were detected. A pooled analysis of the detection of molecular changes could not be performed. Heterogeneity was moderate to high, although the quality of the studies was acceptable. ConclusionsPleural CB is a safe technique with a high yield for etiological diagnosis of pleural effusion, and larger specimens with fewer artifacts are obtained. Molecular determinations should be investigated in more depth.

Pleural Cryobiopsy versus Flexible Forceps Biopsy in Subjects with Undiagnosed Exudative Pleural Effusions Undergoing Semirigid Thoracoscopy: A Crossover Randomized Trial (COFFEE Trial)

Background: There is no randomized study comparing pleural cryobiopsy (CB) and flexible forceps biopsy (FFB) in subjects undergoing medical thoracoscopy for the diagnosis of pleural effusions. Objective: In this crossover study, we compared the diagnostic yield of CB versus FFB in subjects undergoing semirigid thoracoscopy. Methods: Subjects undergoing semirigid thoracoscopy for undiagnosed pleural effusions were subjected to both CB and FFB, with the order of performing the biopsy randomized in a 1:1 ratio. The primary outcome was the diagnostic yield obtained with CB versus FFB. The secondary outcomes included the biopsy size, depth, histologic interpretability, artefacts, the difficulty of performing biopsy on an operator-rated visual analog scale, the severity of bleeding observed at the time of the biopsy, and the duration of the procedure. Results: Of the 201 subjects screened, 50 (mean age 52.4 years; 18 women) were included. The diagnostic yield of CB (78.0%) was not different from FFB (76.0%, p = 1.00). CB yielded a larger specimen than FFB (median size 7.0 vs. 4.0 mm; p < 0.001), and a greater depth of specimens (up to the pleural fat or deeper, CB vs. FFB 65.2 vs. 40.8%; p = 0.02). The CB procedure was quicker than FFB (median duration 10 vs. 15 min; p < 0.001). There were no significant differences in the difficulty of performing the biopsy, the severity of bleeding, histologic interpretability, or artefacts in the specimens between the CB and FFB groups. Conclusion: The diagnostic yield of pleural CB was comparable to FFB during semirigid thoracoscopy.

Safety and Usefulness of Cryobiopsy and Stamp Cytology for the Diagnosis of Peripheral Pulmonary Lesions.

Reports on the use of cryobiopsy (CB) for lung cancer diagnosis are limited. The aims of the present study were to evaluate the safety and usefulness of CB using radial endobronchial ultrasonography, without a guide sheath, for the diagnosis of peripheral pulmonary lesions and determine the utility of stamp cytology, an on-site diagnostic technique for determining tumor inclusion in CB samples. We retrospectively analyzed data for 35 patients (36 lesions) with suspected peripheral lung cancer who underwent CB between August 2017 and February 2019 at our medical facility. The diagnostic yield, incidence of complications, and the utility of stamp cytology for diagnosis were investigated. The diagnostic yield of CB was 86.1% (31/36) with histological diagnosis, and 80.5% (29/36) with diagnosis using stamp cytology; the overall yield was 91.6% (33/36). Pneumothorax requiring thoracic drainage occurred in two patients, both of whom had lesions contacting the pleura. Grade 2 and grade 1 bleeding occurred in one and 25 patients, respectively. CB enables the collection of very large, nearly intact tissue samples, thus resulting in an improvement in the true diagnosis rate and facilitating the measurement of multiple biomarkers as well as rapid histological diagnosis.

P1.05-13 The Demonstration of the Possibility of the Pleura Cryo Biopsy – A Preliminary Report

P1.05-13 The Demonstration of the Possibility of the Pleura Cryo Biopsy – A Preliminary Report

The role of transbronchial cryobiopsy in lung transplantation.

Lung transplant monitoring is usually performed with forceps transbronchial biopsies. These types of biopsy show limited reliability and a high degree of variability, owing to insufficient material and compression artefact, which lead to misinterpretation and, eventually, inappropriate treatment of the transplanted patients. The following study was undertaken to assess the diagnostic yield, histological quality and safety of cryobiopsy (CB) in comparison with conventional forceps biopsy (FB) for sampling lung tissue in transplant recipients. From January to December 2011, 81 consecutive transbronchial biopsies (41 FBs and 40 CBs) were indicated in single or bilateral lung transplantation recipients with clinical acute or chronic lung injury. Lung samples obtained by CB were larger (8.5 ± 6.5 mm in the FB group versus 22.1 ± 12.5 mm in the CB group; P < 0.0001) and had no crush artefacts (P = 0.002), allowing us to increase the diagnostic yield of acute (P = 0.0657) and chronic (P = 0.0053) cellular rejection. Transbronchial cryoprobe bronchoscopy allows the harvesting of larger and more expanded lung tissue samples, increasing the diagnostic yield in the monitoring of the lung allograft by means of a safe procedure.

Does cryoprobe biopsy increase the diagnostic yield in endobronchial tumor lesions?

Background Lung cancer is considered to be one of the most common causes of death among patients with confirmed cancer all over the world. Bronchoscopic diagnosis with ordinary forceps biopsy (FB) is applied primarily for those with endobronchial mass or with suspected visible abnormalities. The small-sized sample is the main limitation for the diagnostic yield by this procedure. Cryoprobe that is mainly used for the cryotherapy purpose has been involved and used nowadays for adequate diagnostic biopsy in patients with suspected endobronchial tumors or lesions. Aim The aim was to compare the flexible cryoprobe with conventional FB regarding diagnostic yield, and to show the feasibility, safety, and possible complications in patients with endobronchial tumor lesions. Patients and methods A total of 40 patients with endoscopically visible lesions were randomized into two groups: group I included 20 patients in whom biopsies were carried out using FB (two samples) and group II included 20 patients in whom biopsies were carried out using cryobiopsy (CB) (one sample). Results There was higher significant diagnostic yield of CB as regards the diameter size, finally diagnosed type of lung cancer and that was diagnosed from the first time bronchoscopy or after redobrochoscopy than FB. Bleeding was the only detected complication during both procedures, but there were no statistically significant difference among both techniques as regards bleeding during procedure, need for hamostatics during the procedure, hemoptysis postprocedure or need for hemostatics postprocedure. Conclusion Endobronchial CB is a safe, successful, and confident technique with superior diagnostic yield compared with ordinary conventional FB mainly because of the larger size and better quality of the obtained specimens’ excellent tissue preservation than that can be used during conventional fiberoptic FB.

Navigational Bronchoscopy-Guided Cryobiopsy for Interstitial Lung Disease: Combining the Best of Two Techniques

SESSION TITLE: Bronchoscopy and Associated Procedures SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Lung biopsies are often used in the evaluation of patients with interstitial lung disease (ILD). For many ILDs, bronchoscopic biopsy (BB) has limited utility due to small biopsy size and the complexity of sampling heterogeneous lung disease, which is the hall mark of ILD. These limited biopsies prove diagnostically challenging to all pathologists. Electromagnetic navigational bronchoscopy (ENB) has been utilized as a technique for improving diagnostic yield from peripheral pulmonary lung lesions (1). However, ENB biopsy samples are often limited due to small tissue size and crush artifact. Cryobiopsy (CB) has become a popular adjunct BB method secondary to larger sample size (2). However, current systems limit the ability to combine ENB with CB. In this case series, we report a novel technique used to combine ENB and cryobiopsy (ENB-CB) and achieve greater tissue yield in BB for patients with ILD. CASE PRESENTATION: Three patients with heterogeneous ILDs were referred to our Interventional Pulmonology Service for biopsy. ENB was performed using the Medtronic SuperDimension System (Minneapolis, MN, USA) with fluoroscopy. Transbronchial biopsies were performed with Medtronic tools. Fluoroscopic images were then saved. The extended working channel from the ENB was removed and the bronchoscope was firmly fixed in a flexed position. A 1.9 mm ERBE cryoprobe (Tubingen, Germany) was passed and guided to the same fluoroscopic location (Figure 1). Using 4-5 second freeze times, two to three CBs were obtained. The CBs were placed in 10% neutral buffered formalin. DISCUSSION: In all 3 cases, ENB-CB resulted in diagnostic material suitable for evaluation and accurate classification of ILD; the amount of tissue allowed for appropriate stains to be performed to establish a pathologic diagnosis and classify the ILD (Figure 2). One patient was diagnosed with hypersensitivity pneumonitis and two patients with cryptogenic organizing pneumonia. There was no incidence of major bleeding; one biopsy was complicated by a pneumothorax that did not require a chest tube. In all cases, ENB-CB provided quantitatively better diagnostic material. ENB-CB blends two current bronchoscopic techniques. Ideally, new tools would allow cryoprobes to be passed through navigational working channels mitigating the need for fluoroscopic alignment. CONCLUSIONS: In this proof of concept case series, we have shown that using ENB-CB with fluoroscopic alignment can achieve large biopsy samples without complications to help direct biopsies for heterogeneous ILDs. A larger trial needs to be conducted to further support the assertions made. Reference #1: Wang Memoli JS, Nietert PJ, Silvestri GA. Met-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest (2012) 142(2): 385-393 Reference #2: Ganganah O et al. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumors: A systemic review and meta-analysis. Respirology (2016) 21: 834-841 DISCLOSURE: The following authors have nothing to disclose: Pankil Desai, Robert Greer, Robert Babkowski, Michael Bernstein No Product/Research Disclosure Information

Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta-analysis.

Forceps biopsy (FB) is the most commonly used diagnostic tool for lung pathologies. FB is associated with a high diagnostic failure rate. Cryobiopsy (CB) is a novel technique providing a larger specimen size, few artefacts, more alveolar parts and superior diagnostic yield. CB, however, has drawbacks such as higher bleeding and pneumothorax rate. We conducted a meta-analysis to investigate the specimen area, diagnostic rate and bleeding severity in CB versus FB in interstitial lung diseases (ILDs) and lung tumours. A systematic literature search of PUBMED, BIOSIS PREVIEW and OVID databases was conducted using specific search terms. Eligible studies including RCTs and non-RCTs comparing cryobiopsy/cryotransbronchial biopsy (CB/CTBB) and forceps biopsy/forceps transbronchial biopsy (FB/FTBB) for specimen area, diagnostic rate and bleeding rate in ILDs and lung tumours were analysed. Two reviewers independently extracted data and evaluated the quality of the studies. Eight studies involving 916 patients were analysed. Specimen area (mm(2) ) was significantly larger in CB/CTBB than FB/FTBB (standard mean difference = 1.21, 95% confidence interval (0.94, 1.48), P < 0.00001). The diagnostic rate was significantly higher in CB/CTBB than FB/FTBB (Risk ratio 1.36, 95% confidence interval (1.16, 1.59), P = 0.0002). Three studies compared the bleeding severity with only one showing significantly more bleeding in CB. Cryobiopsy/cryotransbronchial shows superiority to FB/FTBB for specimen area and diagnostic rate. CB/CTBB has better efficacy over FB/FTBB.