The ThinICE protocol: the combination of cryobiopsy and ultrahin bronchoscopy for the peripheral lung nodule.

L. Giuntoli*^a (Dr), V. Luzzi^a (Dr), L. Ciani^a (Dr), M. Trigiani^a (Dr), L. Gori^a (Dr), L. Corbetta^a (Prof), R. Piperio^a (Dr), A. Sorano^a (Dr), F. Potenza^b (Dr), S. Ferraro^a (Dr), V. Pasini^a (Dr), C. Ammatuna^a (Dr), F. Lavorini^a (Prof), C. Comin^a (Prof), E. Rosi^a (Dr), S. Tomassetti^a (Prof)

^a Aou-Careggi, Florence, ITALY ; ^b Aou-Careggi, Firenze, ITALY

* leogiuntoli@gmail.com

Introduction: Endoscopic sampling of lung lesions is a key moment in the diagnostic process, for both histologic diagnosis and bimolecular profiling of lung lesions. Given the low diagnosis likelihood of current endoscopic techniques, we propose a novel technique using the “ultrathin” 3mm bronchoscope with the 1.1mm cryoprobe as the sampling tool, for lung lesions not directly visible with standard bronchoscope.

Objective: The main aim of the study is to determine the superiority of combined ultrathin and cryobiopsy versus regular bronchoscope and regular forceps biopsy, measured as diagnostic yield. Secondary aim of the study include: Safety and feasibility, adequacy and quality both ROSE and histology evaluation.

Methods: The study is a multi centric, prospective and randomised trial between two groups. One group is assigned to “ultra thin” in which sampling of the lesion is conducted with the ultrathin instrument and the 1.1mm cryoprobe. The second group is assigned to “conventional” in which sampling is obtained using the “standard” 4 or 6mm bronchoscope with endoscopic forceps.

Results: The study has just started only at our centre and is currently ongoing. To date we have enrolled 4 patients in the ultra thin group: in all 4 we were able to endoscopically identify a lesion. In 3 out 4 cases fluoroscopy was needed. In 3 patients we achieved histologic diagnosys via cryobiopsy only, with one case still pending. In all cases ROSE showed a richer cellularity than usually seen with the conventional biopsy using the endoscopic forceps resulting in easier detection of atypical cells. So far no difference were noticed between the groups regarding adverse effect.

Discussion: The use of ultra thin endoscope associated with the use of the 1.1 mm cryoprobe could prove to be a useful tool in the diagnosys of the periferal lung lesions with or without the use of fluoroscopy.

Disclosure of funding source(s): none