Morphometrical analysis of transbronchial cryobiopsies

Sergej Griff, Wim Ammenwerth, Nicolas Schönfeld, Torsten T Bauer, Thomas Mairinger, Torsten-Gerriet Blum, Jens Kollmeier, Wolfram Grüning, Sergej Griff, Wim Ammenwerth, Nicolas Schönfeld, Torsten T Bauer, Thomas Mairinger, Torsten-Gerriet Blum, Jens Kollmeier, Wolfram Grüning

Abstract

The recent introduction of bronchoscopically recovered cryobiopsy of lung tissue has opened up new possibilities in the diagnosis of neoplastic and non-neoplastic lung diseases in various aspects. Most notably the morphological diagnosis of peripheral lung biopsies promises to achieve a better yield with a high quality of specimens. To better understand this phenomenon, its diagnostic options and perspectives, this study morphometrically compares 15 cryobiopsies and 18 transbronchial forceps biopsies of peripheral lung tissue a priori without considering clinical hit ratio or integration of results in the clinical diagnostic processing. Cryotechnically harvested specimens were significantly larger (mean: 17.1 ± 10.7 mm2 versus 3.8 ± 4.0 mm2) and contained alveolar tissue more often. If present, the alveolar part in cryobiopsies exceeded the one of forceps biopsies. The alveolar tissue of crybiopsy specimens did not show any artefacts. Based on these results cryotechnique seems to open up new perspectives in bronchoscopic diagnosis of lung disease.

Figures

Figure 1
Figure 1
left: Cryobiopsy, right: Conventional forceps biopsy.
Figure 2
Figure 2
Specimen Size, graph in μm2, statistical data in mm2.
Figure 3
Figure 3
Size of the alveolar part, graph in μm2, statistical data in mm2.

References

    1. Berbescu EA, Katzenstein AL, Snow JL, Zisman DA. Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006;129(5):1126–1131. doi: 10.1378/chest.129.5.1126.
    1. Katzenstein AL, Askin FB. Interpetation and significance of pathologic findings in transbronchial lung biopsy. Am J Surg Pathol. 1980;4(3):223–234. doi: 10.1097/00000478-198006000-00002.
    1. Joyner LR, Scheinhorn DJ. Transbronchial forceps lung biopsy through the fiberotic bronchoscope. Diagnosis of diffuse pulmonary disease. Chest. 1975;67:532–535. doi: 10.1378/chest.67.5.532.
    1. Katzenstein AL. Katzenstein and Askin's surgical Pathology of non-neoplastic lung disease. 4. Saunders Company; 2006. Transbronchial lung biopsy; pp. 477–491.
    1. Zavala DC. Diagnostic fiberotic bronchoscopy. Techniques and results of biopsy in 600 patients. Chest. 1975;68:12–19. doi: 10.1378/chest.68.1.12.
    1. Fraire AE, Cooper SP, Greenberg SD, Rowland LP, Langston C. Transbronchial lung biopsy: histopathologic and morphometric assessment of diagnostic utility. Chest. 1992;102:748–752. doi: 10.1378/chest.102.3.748.
    1. Payne CR, Hadfield JW, Stovin PG, Barker V, Heard BE, Stark JE. Diagnostic accuracy of cytology and biopsy in primary bronchial carcinoma. J Clin Pathol. 1981;34:773–778. doi: 10.1136/jcp.34.7.773.
    1. Rudd RM, Gellert AR, Boldy DAR, Studdy PR, Pearson MC, Geddes DM, Sinha G. Bronchoscopic and percutaneus aspiration biopsy in the diagnosis of brochial cell type. Thorax. 1982;37:462–465. doi: 10.1136/thx.37.6.462.
    1. Franke KJ, Nilius G, Rühle KH. Bronchocopic diagnosis of peripheral pulmonary foci. Dtsch Med Wochenschr. 2006;131:2229–2233. doi: 10.1055/s-2006-951358.
    1. Descombes E, Gardiol D, Leuenberger P. Transbronchial lung biopsy: an analysis of 530 cases with reference to the number of samples. Moaldi Arch Chest Dis. 1997;52(4):324–329.
    1. Baaklini WA, Reinoso MA, Gorin AB, Sharafkaneh A, Manian P. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest. 2000;117:1049–1054. doi: 10.1378/chest.117.4.1049.
    1. Schönfeld N, Frank W, Wenig S, Uhrmeister P, Allica E, Preussler H, Grassot A, Loddenkemper R. Clinical and radiologic features, lung function and therapeutic results in pulmonary histiocytosis X. Respiration. 1993;60(1):38–44.
    1. Sheski FD, Mathur PN. Endoscopic treatment of early-stage lung cancer. Cancer Control. 2000;7:35–44.
    1. Mathur PN, Wolf KM, Busk MF, Briete WM, Datzman M. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest. 1996;110:718–723. doi: 10.1378/chest.110.3.718.
    1. Maiwand MO, Asimakopoulos G. Cryosurgery for lung cancer: clinical results and technical aspects. Technol Cancer Res Treat. 2004;3:143–150.
    1. Hetzel M, Hetzel J, Schumann C, Marx N, Babiak A. Cryorecanalization: a new approach for the immediate management of acute airway obstruction. J Thorac Cardiovasc Surg. 2004;127:1427–1431. doi: 10.1016/j.jtcvs.2003.12.032.
    1. Franke KJ, Theegarten D, Hann von Weyhern C, Nilius G, Brueckner C, Hetzel J, Hetzel M, Ruhle KH, Enderle MD, Szyrach MN. Prospective controlled animal study on biopsy sampling with new flexible cryoprobes versus forceps: evaluation of biopsy size, histological quality and bleeding risk. Respiration. 2010;80(2):127–132. doi: 10.1159/000287251.
    1. Schumann C, Hetzel J, Babiak AJ, Merk T, Wibmer T, Möller P, Lepper PM, Hetzel M. Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions. J Thorac Cardiovasc Surg. 2010;140(2):417–421. doi: 10.1016/j.jtcvs.2009.12.028.
    1. Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli T, Hetzel M. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration. 2009;78(2):203–208. doi: 10.1159/000203987.
    1. Aktas Z, Gunay E, Hoca NT, Yilmaz A, Demirag F, Gunay S, Sipit T, Kurt EB. Endobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis. Ann Thorac Med. 2010;5(4):242–246. doi: 10.4103/1817-1737.69117.

Source: PubMed

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