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

Tatsuya Imabayashi, Junji Uchino, Akihiro Yoshimura, Yusuke Chihara, Nobuyo Tamiya, Yoshiko Kaneko, Tadaaki Yamada, Koichi Takayama, Tatsuya Imabayashi, Junji Uchino, Akihiro Yoshimura, Yusuke Chihara, Nobuyo Tamiya, Yoshiko Kaneko, Tadaaki Yamada, Koichi Takayama

Abstract

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.

Keywords: bronchoscopy; cell biology; cryobiopsy; lung cancer; ultrasonography.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram showing the results of cryobiopsy (CB) in 35 patients with peripheral pulmonary lesions.
Figure 2
Figure 2
The cryoprobe bending method for peripheral pulmonary lesions. (a) When the cryoprobe has been bent as far as possible toward the lung apex, (b) the scope is bent in a down angle. (c) The shape memory property of the probe can be used to push it completely toward the lung apex. (d) Forward feeding of the cryoprobe instead of a guidewire, with simultaneous advancement of the scope, enables the confirmation of probe entry into the correct bronchus.
Figure 3
Figure 3
Surface area of peripheral lung lesion samples obtained via cryobiopsy according to the freezing time during cryobiopsy. The graph shows that a larger surface area can be obtained with an increased freezing time (p = 0.007).
Figure 4
Figure 4
Severity (grade) of bleeding according to (a) the cryobiopsy number (first, second, third) and (b) the freezing time during cryobiopsy (2-, 3-, 4- and 5-s) in patients with peripheral pulmonary lesions. The severity of bleeding did not differ according to the number of biopsies (p = 0.913; Figure 4a) or the freezing time (p = 0.451; Figure 4b).

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