Ultrathin bronchoscopic cryobiopsy of peripheral pulmonary lesions

Oki M, Saka H, Kogure Y, et al.

Respirology 2022;1-9. 10.1111/resp.14360

What is the key question?

  • As more pulmonary nodules are investigated using less invasive techniques such as bronchoscopy, as opposed to image guided techniques or surgery and cryobiopsy is becoming more accessible, smaller and more peripheral lesions are being considered for biopsy using the cryobiopsy technique. This study investigates whether this technique is feasible, as accurate for diagnosis and as safe as conventional techniques.

What is the bottom line?

  • In this study of 50 patients, there were no significant bleeding complications and the yield for cryobiopsy diagnosis was 62%. Forceps biopsies in the same patients yielded a diagnosis in 54%. The two techniques combined increased the yield to 74%. Although washings for cytology and microbiology were also performed, they were not reported.
  • Despite some limitations, this small study suggests that ultra-thin cryobiopsy is a safe technique for biopsy of peripheral lung lesions when used with bleeding protection. It appears from these small numbers that the usual technical limitations apply, including the presence of a bronchus sign and the position of the probe relative to the lesion. Sensitivity and specificity are likely to be slightly higher than would be expected using conventional biopsy techniques, particularly in those lesions where the probe is not within the lesion.

Why read on?

  • This study offers early data in an area that will become a more routine part of bronchoscopy practice over time. More studies are required to determine how this technique will be utilised to maximum benefit.