Endobronchial ultrasound-guided cryobiopsy: a new frontier?
AJ. De Grauw*a (Dr), F. Sultania (Dr), S. Martinelloa (Dr), C. Ghirottia (Dr), V. Polettia (Prof), C. Ravagliaa (Dr)
a Ospedale Morgagni-Pierantoni (Forlì), Forlì, ITALY
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and safe technique, widely practiced and included in guidelines as one of the preferred strategies to stage non-small cell lung cancer (NSCLC). It is also used for the diagnosis of other diseases, such as other intrathoracic cancers, sarcoidosis and lymphomas. A limitation of this technique is sample size, which can render further, often more invasive, testing necessary. Recently, a new approach has been suggested: EBUS-guided cryobiopsy. We present a case series of 10 patients who underwent sampling through EBUS-guided cryobiopsy in our unit.
The age of the subjects ranged from 37 to 74 (average 56 years), six males and four females. The procedures were performed in general anaesthesia with intubation, as is standard procedure in our unit for EBUS-TBNA. We used a 19G needle to perform EBUS-TBNA, followed by cryobiopsies with a 1.1 mm cryoprobe through the opening created with the needle (avoiding use of needle-knife as reported elsewhere), freezing time 3-4 seconds. There were no procedure-related complications. In eight cases lymph nodes were sampled, while in the remaining two cases a peri-bronchial mass was sampled. The procedures were all diagnostic: NSCLC in four cases, sarcoidosis in three cases, one Hodgkin lymphoma, one amartoma and one benign lymph node hyperplasia. Diagnosis was always concordant between EBUS-TBNA and EBUS-cryobiopsy, with the larger sample size of the cryobiopsies posing a definite advantage in one case of NSCLC, as EBUS-TBNA samples were not sufficient for complete mutational and molecular testing, and in the case of Hodgkin lymphoma, as it allowed precise immunophenotyping.
This case-series further supports the promising new literature available, suggesting that EBUS cryobiopsies are feasible, safe and a possible new frontier in the sampling not only of mediastinal lymph nodes, but also of other lesions identifiable with EBUS.
Disclosure of funding source(s): none