A pilot study of the ultrathin cryoprobe in the diagnosis of peripheral pulmonary ground-glass opacity lesions

Simin Jiang, Xiaojun Liu, Junxiang Chen, Haifeng Ma, Fangfang Xie, Jiayuan Sun, Simin Jiang, Xiaojun Liu, Junxiang Chen, Haifeng Ma, Fangfang Xie, Jiayuan Sun

Abstract

Background: It is very difficult to obtain samples of peripheral pulmonary ground-glass opacity lesions (GGOs) by traditional transbronchial biopsy. This study was conducted to evaluate the diagnostic efficacy and safety of transbronchial cryobiopsy (TBCB) of GGOs using a newly developed ultrathin cryoprobe with an outer diameter of 1.1 mm.

Methods: We retrospectively analyzed 20 patients with 23 GGOs who underwent TBCB using the ultrathin cryoprobe from October 2018 to November 2019 in the Shanghai Chest Hospital. The TBCB procedure was performed under the guidance of virtual bronchoscopic navigation (VBN), electromagnetic navigation bronchoscopy (ENB), endobronchial ultrasound, and fluoroscopy. We collected the baseline information of participants, reported diagnostic yield and complications, and analyzed factors may have affected the diagnostic yield.

Results: A total of 23 GGOs (12 pure GGOs, 11 mixed GGOs), with an average diameter of 21.58±11.88 mm, underwent TBCB, and the diagnostic yield was 82.61% (19/23). Of the 19 GGOs diagnosed by TBCB, 12 were adenocarcinomas, 5 were inflammation, 1 was occupational interstitial lung disease, and 1 was a pulmonary meningothelial-like nodule. The remaining 4 undiagnosed lesions were confirmed to be adenocarcinomas by further analysis. The diagnostic yield was unchanged by factors including size (GGOs ≥20 mm, GGOs <20 mm), navigation (VBN, ENB), fluoroscopic visibility (visible, invisible), GGO-component (pure GGOs, mixed GGOs), and guide sheath (K-201, K203). There was no presentation of pneumothorax or severe hemorrhage.

Conclusions: The ultrathin cryoprobe is feasible, safe, and has a high diagnostic yield in the diagnosis of pulmonary GGOs. There is vast potential for the ultrathin cryoprobe as a tool for the diagnosis of GGOs, especially for cases suspicious of early-stage lung cancer.

Trial registration: ClinicalTrials.gov. No: NCT03716284. Registered: 20 October, 2018. URL: ClinicalTrials.gov.

Keywords: Diagnosis; ground-glass opacity (GGO); lung cancer; transbronchial cryobiopsy (TBCB); transbronchial lung biopsy (TBLB).

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-957). The authors have no conflicts of interest to declare.

2020 Translational Lung Cancer Research. All rights reserved.

Figures

Figure 1
Figure 1
Different assembly of bronchoscope, endobronchial ultrasound (EBUS), guide sheath (GS), and ultrathin cryoprobe. (A) The standard bronchoscope (BF-1TQ290/BF-1T260, distal end outer diameter 5.9 mm, working channel 3.0 mm), EBUS (UM-S20-20R, outer diameter 1.7 mm), GS (K-203, outer diameter 2.55 mm), and the ultrathin cryoprobe (outer diameter 1.1 mm) were used together. (B) The thin bronchoscope (BF-P290/BF-P260, distal end outer diameter 4.2 mm, working channel 2.0 mm) was engaged with EBUS (UM-S20-17S, outer diameter 1.4 mm), GS (K-201, outer diameter 1.95 mm), and the ultrathin cryoprobe. (C) The ultrathin bronchoscope (UTB, BF-XP290, Olympus, distal end outer diameter 3.1 mm, working channel 1.2 mm) was directly combined with the ultrathin cryoprobe.
Figure 2
Figure 2
Representative case 1 of (TBCB) using the standard bronchoscope (BF-1TQ290) with electromagnetic navigation bronchoscopy (ENB). (A) The axial section of high-resolution computed tomography (HRCT) showed that the GGO was located in the apical segment of the right upper lobe (RUL). (B) The coronal plane of HRCT showed where the GGO was located. (C) The ENB presented a real-time interface where the tracking wire reached the target. (D) The endobronchial ultrasound (EBUS) image showed the blizzard sign. (E) The location of the EBUS probe (UM-S20-20R) was visualized by X-ray fluoroscopy to confirm its arrival. (F) After confirming arrival of the bronchoscope, the EBUS probe was retracted and cryobiopsy was performed via the K-203 GS. (G) H&E staining of the specimen with the magnification of ×4. (G1) Magnification of the right upper corner of the specimen showed acinar adenocarcinoma (magnification, ×20). (G2) Magnification of the left lower corner of the specimen displays adenocarcinoma with lepidic pattern (magnification, ×20).
Figure 3
Figure 3
Representative case 2 of transbronchial cryobiopsy (TBCB) using the thin bronchoscope (BF-P290) with ENB. (A) The high-resolution computed tomography (HRCT) axial section showed that the ground-glass opacity (GGO) was located in the apical segment of the right upper lung (RUL). (B) The HRCT coronal plane showed where the GGO was located. (C) Electromagnetic navigation bronchoscopy (ENB) showed the real-time interface where the positioning wire reaches the target. (D) Endobronchial ultrasound (EBUS) displayed “Blizzard sign”. (E) Location of the ultrasound probe (UM-S20-17S) was visualized by X-ray to confirm its arrival. (F) After confirming the arrival of bronchoscope, the ultrasound probe was retracted and cryobiopsy was performed via the K-201 GS. (G) Hematoxylin and eosin (H&E) staining of the specimen with the magnification of ×2. (G1) Magnification of the pointed area displays the transition from normal pulmonary alveoli to atypical hyperplastic area (magnification, ×10). (G2) Magnification of the left lower parts of the specimen showed adenocarcinoma with lepidic pattern (magnification, ×10).
Figure 4
Figure 4
Representative case 3 of transbronchial cryobiopsy (TBCB) using the ultrathin bronchoscope (UTB) (BF-XP290) guided by virtual bronchoscopic navigation (VBN). (A) The high-resolution computed tomography (HRCT) axial section showed a pure ground-glass opacity (GGO) located in the anterior segment of the left upper lobe, with blood vessel involvement. (B) The HRCT coronal plane showed the GGO location. (C) Bronchial path and virtual bronchography of VBN. (D) The ultrathin cryoprobe was inserted into the target bronchus under the direct vision of the UTB. (E) Cryobiopsy was conducted under X-ray fluoroscopy. (F) Hematoxylin and eosin (H&E) staining of the specimen with the magnification of ×4. (F1) Enlarged picture displays atypical hyperplasia (magnification, ×20). It was confirmed as adenocarcinoma in situ by surgery.

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