Citation Information :
Arbat S, Singh T, Arbat T, Laura S. Hybrid Technique of Radial Endobronchial Ultrasound Combined with Lung Cryobiopsy in the Diagnosis of Peripheral Pulmonary Lesions. Indian J Respir Care 2023; 12 (1):42-45.
Introduction: The diagnosis of peripheral pulmonary lesions (PPLs) may be challenging as they are bronchoscopically invisible. Radial endobronchial ultrasound (EBUS) is useful for accessing PPL, with the help of transbronchial lung biopsy (TBLB) and cryoprobe. Although PPL can also be accessed with the help of transthoracic ultrasound or computerized tomography (CT)—guided fine-needle aspiration (FNA), there is a significant risk of pneumothorax.
Patients and methods: This was a retrospective observational study. Patients with PPL on CT thorax were subjected to bronchoscopy. Radial EBUS (R-EBUS) via flexible bronchoscope with fluoroscope was used to determine the site and cryobiopsy was taken. Bleeding was controlled by an endobronchial balloon placed through a rigid bronchoscope as a conduit.
Results: A total of 40 patients underwent R-EBUS with fluoroscopy-guided cryobiopsy. Histopathological diagnosis was achieved in 34 (85%) cases. Out of total 40 cases, 10 were diagnosed as adenocarcinoma, 9 as squamous cell carcinoma, and 4 as bronchitis and so on. No complication was seen in 12 cases, and 1 patient required hospitalization for observation.
Conclusions: R-EBUS-guided cryobiopsy in the diagnosis of PPLs is a safe procedure with good diagnostic yield.
Sryma PB, Mittal S, Madan NK, et al. Efficacy of Radial Endobronchial Ultrasound (R–EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL's): A systematic review and meta-analysis. Pulmonology 2021; ???:X2531-.-X.
Jiang L, Xu J, Liu C, et al. Diagnosis of peripheral pulmonary lesions with transbronchial lung cryobiopsy by guide sheath and radial endobronchial ultrasonography: A prospective control study. Can Respir J 2021;2021:1–8.
Nasim F, Ost DE. Management of the solitary pulmonary nodule. Curr Opin Pulm Med 2019;25:344–353.
Truong MT, Ko JP, Rossi SE, et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics 2014;34:1658–1679.
Herath S, Yap E. Novel hybrid Cryo–radial method: An emerging alternative to CT-guided biopsy in suspected lung cancer. A prospective case series and description of technique. Respirol Case Rep 2018;6:e00287.
Prosch H, Stadler A, Schilling M, et al. CT fluoroscopy–guided versus multislice CT biopsy mode–guided lung biopsies: Accuracy, complications and radiation dose. Eur J Radiol 2012;81:1029–1033.
Kho SS, Chan SK, Yong MC, et al. Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions. ERJ Open Res 2019;5:00135–02019.
Schuhmann M, Bostanci K, Bugalho A, et al. Endobronchial ultrasound-guided cryobiopsies in peripheral pulmonary lesions: A feasibility study. Eur Respir J 2014;43:233–239.
Sheski FD, Mathur PN. Endoscopic treatment of early–stage lung cancer. Cancer Control 2000;7:35–44.
Wang Memoli JS, Nietert PJ, Silvestri GA. Meta–analysis of guided bronchoscopy for the evaluation of the pulmonary nodule. Chest 2012;142:385–393.
Hetzel J, Eberhardt R, Herth FJ, et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: A multicentre trial. Eur Respir J 2012;39:685–690.
Ravaglia C, Bonifazi M, Wells AU, et al. Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: A comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literature. Respiration 2016;91:215–227.