Radial EBUS guided transbronchial cryobiopsy for diagnosis of middle third lung lesions

Abstract: Transbronchial lung cryobiopsy (TBCB) is an effective technique to obtain tissue samples for pathological examination. However, TBCB in middle third lung lesions was presumed to be associated with significant hemorrhage. Objectives: To evaluate safety of TBCB for middle third lung lesions and compare it with outer third lung lesions. Methods: The lesions were divided radiologically into middle and outer thirds groups based on CT. Radial ultrasound mini-probe (RP-EBUS) was introduced through a thin bronchoscope (Olympus) to identify the lesions and surrounding vessels. Virtual bronchoscopy system (Lung Quest software/bronchus Lung Point systems) was used in 6 patients. In eligible lesions (no surrounding large vessels ≥3 mm or hypervascularization seen by thin-slice chest CT or RP-EBUS), 4 TBCB were performed using a flexible cryoprobe 1.9 mm (ERBE). Results: 26 patients with parenchymal lung lesions were included from March 2015 to January 2017. 15 patients had middle third lung lesions with mean diameter 39.9 mm. Out of them, 3 patients were excluded for TBCB (20%). 7 were positive for adenocarcinoma (58.3%) and moderate bleeding occurred in 5/12 (41.7%). 11 patients had peripheral third lesions with mean diameter 43.1 mm. 1 patient was excluded for TBCB (9.1%). 4 were positive for adenocarcinoma, 1 was undifferentiated NSCLC, 1 was UIP and 1 was colloid carcinoma. Diagnostic value was (70%) and moderate bleeding occurred in 2/10 (20%). Conclusions: RP-EBUS guided TBCB for middle third lung lesions was not associated with severe complications; however tendency to moderate bleeding was higher. Carefull selection of potential candidates is mandatory Funded partially by a grant AEER 2016